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Kaumudi Joshipura

Publications and source records attributed to Kaumudi Joshipura.

16 recordsLinked to original sources
PubMed2007

Prospective study of vitamins C, E, and A and carotenoids and risk of oral premalignant lesions in men.

Case-control studies indicate that vitamins C, E, A and carotenoids decrease risk of oral premalignant lesions (OPLs) and oral cancer, but clinical trials have failed to find protective effects of beta-carotene and suggest that vitamin E may increase risk. The authors prospectively evaluated the association between intake of vitamins C, E, A and carotenoids and incidence of OPL. Participants were 42,340 men in the Health Professionals Follow-up Study who provided information on supplement use and diet every 2-4 years by food frequency questionnaire. The authors confirmed 207 clinically or histopathologically diagnosed OPL events occurring between 1986 and 2002 by medical record review. Multivariate-adjusted relative risks (RR) of OPL were calculated with proportional hazards models. Total intake of vitamin C, vitamin A or carotenoids was not significantly associated with OPL risk. Dietary vitamin C was significantly associated with reduced risk (quintile 5 vs. 1, RR = 0.52, 95% CI 0.31-0.85, p(trend) = 0.04), but no association with supplemental vitamin C was observed. Inverse associations were apparent for beta-cryptoxanthin and alpha-carotene intake. No clear relationship emerged with beta-carotene, lycopene or lutein/zeaxanthin. Vitamin E was associated with increased risk (quintile 5 vs. 1, RR = 1.86, 95% CI 1.06-3.19), particularly among current smokers and with supplemental intake (current-smokers, supplement dose tertile 3 vs. 1, RR = 3.07, 95% CI 1.28-7.34, p(trend) = 0.01). For current smokers, beta-carotene also increased risk. Vitamin C from dietary sources, but not supplements, was associated with a reduced risk of OPL. The observed increased risk for current smokers with high vitamin E or beta-carotene intake should be explored further.

Adult↗
PubMed2007

A prospective study of periodontal disease and pancreatic cancer in US male health professionals.

Two previous cohort studies reported positive associations between tooth loss or periodontitis and pancreatic cancer risk. Data on periodontal disease were obtained at baseline and every other year thereafter in a cohort of 51,529 male health professionals aged 40-75 years. A total of 216 patients were diagnosed with incident pancreatic cancer during 16 years of follow-up. Multivariable relative risks (RRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models controlling for potential confounders, including detailed smoking history. All statistical tests were two-sided. Compared with no periodontal disease, history of periodontal disease was associated with increased pancreatic cancer risk (overall, multivariable RR = 1.64, 95% CI = 1.19 to 2.26; P = .002; crude incidence rates: 61 versus 25 per 100,000 person-years; among never smokers, multivariable RR = 2.09, 95% CI = 1.18 to 3.71; P = .01; crude incidence rates: 61 versus 19 per 100,000 person-years). In contrast, baseline number of natural teeth and cumulative tooth loss during follow-up were not strongly associated with pancreatic cancer. The association between periodontal disease and increased risk of pancreatic cancer may occur through plausible biologic mechanisms, but confirmation of this association is necessary.

Adult↗
PubMed2006

Prospective study of fruits and vegetables and risk of oral premalignant lesions in men.

The authors prospectively evaluated fruit and vegetable consumption and the incidence of oral premalignant lesions among 42,311 US men in the Health Professionals Follow-up Study. Diet was assessed every 4 years by food frequency questionnaires. The authors confirmed 207 cases of clinically or histopathologically diagnosed oral premalignant lesions occurring between 1986 and 2002. Multivariate-adjusted relative risks were calculated from proportional hazards models. Significant inverse associations were observed with citrus fruits, citrus fruit juice, and vitamin-C-rich fruits and vegetables, indicating 30-40% lower risks with greater intakes (e.g., citrus fruit juice quintile 5 vs. quintile 1 relative risk = 0.65, 95% confidence interval: 0.42, 0.99). Inverse associations with fruits did not vary by smoking status and were stronger in analyses of baseline consumption, with a 10-year lag time to disease follow-up (quintile 5 vs. quintile 1 relative risk = 0.41, 95% confidence interval: 0.20, 0.82; p = 0.01). No associations were observed with total vegetables or with beta-carotene-rich or lycopene-rich fruits and vegetables. For current smokers, green leafy vegetables (ptrend = 0.05) and beta-carotene-rich fruits and vegetables (ptrend = 0.02) showed significant linear trends of increased risk (one additional serving/day relative risk = 1.7). The risk of oral premalignant lesions was significantly reduced with higher consumption of fruits, particularly citrus fruits and juices, while no consistent associations were apparent for vegetables.

Adult↗
PubMed2005

The accuracy of individual self-reported items to determine periodontal disease history.

The objective of this study was to evaluate the validity of self-reported periodontal disease and symptoms to predict periodontal disease history in a German population. We analysed data from 246 patients who answered a self-administered questionnaire on self-perceived periodontal disease and self-reported symptoms of periodontal disease. Actual periodontal status was assessed from panoramic radiographs and periodontal disease was defined as > or = 3 teeth with radiographic alveolar bone loss (ABL) > 5 mm (prevalence 39%). Sensitivity (SN) and specificity (SP) of self-reported items for diagnosis of periodontal disease history were calculated. The diagnostic accuracy of any individual item was generally low. For example, self-perceived periodontal disease had SN of 49% and SP of 67%. All self-reported items had low sensitivity, while self-reported professionally diagnosed bone loss, tooth loss caused by periodontal disease and mobility had SP > 90%. In conclusion, we did not identify a single individual question that can assess periodontal disease from self-reporting with satisfactory validity. Future studies will evaluate whether multivariate prediction rules using information from several self-reported variables are a valid means to ascertain periodontal disease history.

Adult↗
PubMed2004

Inflammatory markers and the risk of coronary heart disease in men and women.

BACKGROUND: Few studies have simultaneously investigated the role of soluble tumor necrosis factor alpha (TNF-alpha) receptors types 1 and 2 (sTNF-R1 and sTNF-R2), C-reactive protein, and interleukin-6 as predictors of cardiovascular events. The value of these inflammatory markers as independent predictors remains controversial. METHODS: We examined plasma levels of sTNF-R1, sTNF-R2, interleukin-6, and C-reactive protein as markers of risk for coronary heart disease among women participating in the Nurses' Health Study and men participating in the Health Professionals Follow-up Study in nested case-control analyses. Among participants who provided a blood sample and who were free of cardiovascular disease at baseline, 239 women and 265 men had a nonfatal myocardial infarction or fatal coronary heart disease during eight years and six years of follow-up, respectively. Using risk-set sampling, we selected controls in a 2:1 ratio with matching for age, smoking status, and date of blood sampling. RESULTS: After adjustment for matching factors, high levels of interleukin-6 and C-reactive protein were significantly related to an increased risk of coronary heart disease in both sexes, whereas high levels of soluble TNF-alpha receptors were significant only among women. Further adjustment for lipid and nonlipid factors attenuated all associations; only C-reactive protein levels remained significant. The relative risk among all participants was 1.79 for those with C-reactive protein levels of at least 3.0 mg per liter, as compared with those with levels of less than 1.0 mg per liter (95 percent confidence interval, 1.27 to 2.51; P for trend <0.001). Additional adjustment for the presence or absence of diabetes and hypertension moderately attenuated the relative risk to 1.68 (95 percent confidence interval, 1.18 to 2.38; P for trend = 0.008). CONCLUSIONS: Elevated levels of inflammatory markers, particularly C-reactive protein, indicate an increased risk of coronary heart disease. Although plasma lipid levels were more strongly associated with an increased risk than were inflammatory markers, the level of C-reactive protein remained a significant contributor to the prediction of coronary heart disease.

Adult↗
PubMed2004

Dietary intake of trans fatty acids and systemic inflammation in women.

BACKGROUND: trans Fatty acid (TFA) intake predicts risks of coronary artery disease and diabetes. Systemic inflammation may be involved in the pathogenesis of such conditions; however, relations between TFA intake and systemic inflammation are not well established. OBJECTIVE: We investigated the relations between TFA intake and inflammatory markers. DESIGN: In 823 generally healthy women in the Nurses' Health Study I and II, concentrations of soluble tumor necrosis factor alpha receptors 1 and 2 (sTNF-R1, sTNF-R2), interleukin 6 (IL-6), and C-reactive protein (CRP) were measured. Usual dietary intakes assessed from 2 semiquantitative food-frequency questionnaires were averaged for each subject. RESULTS: In age-adjusted analyses, TFA intake was positively associated with sTNF-R1 and sTNF-R2 (P for trend < 0.001 for each): sTNF-R1 and sTNF-R2 concentrations were 10% (+108 pg/mL; 95% CI: 50, 167 pg/mL) and 12% (+258 pg/mL; 138, 377 pg/mL) higher, respectively, in the highest intake quintile than in the lowest. These associations were not appreciably altered by adjustment for body mass index, smoking, physical activity, aspirin and nonsteroidal antiinflammatory drug use, alcohol consumption, and intakes of saturated fat, protein, n-6 and n-3 fatty acids, fiber, and total energy. Adjustment for serum lipid concentrations partly attenuated these associations, which suggests that they may be partly mediated by effects of TFAs on serum lipids. TFA intake was not associated with IL-6 or CRP concentrations overall but was positively associated with IL-6 and CRP in women with higher body mass index (P for interaction = 0.03 for each). CONCLUSIONS: TFA intake is positively associated with markers of systemic inflammation in women. Further investigation of the influences of TFAs on inflammation and of implications for coronary disease, diabetes, and other conditions is warranted.

Adult↗
PubMed2004

Can nonstandardized bitewing radiographs be used to assess the presence of alveolar bone loss in epidemiologic studies?

OBJECTIVE: To compare periodontitis-associated alveolar bone loss assessment by standardized and nonstandardized radiographs in clinical and epidemiologic studies. METHODS: Participants included 37 patients aged 21-66 years with prior nonstandardized bitewing radiographs scheduled to receive bitewing radiographs as part of their next routine dental care visit. Standardized bitewing radiographs were taken with a Rinn film holder to position the film in the mouth and align the X-rays so that they were at 90 degrees to the film. Before taking the radiograph the bite was registered in centric relation using a polyether impression material. One registered dental hygienist took and processed all the standardized radiographs. One dentist read all radiographs using a viewing box, magnifying lens, and periodontal probe with William's markings. Radiographic bone loss was measured to the closest millimeter at mesial and distal sites of the posterior teeth excluding third molars. The examining dentist was blinded to the participant's name, age, gender, or if the radiograph was standardized or nonstandardized. RESULTS: Mean bone loss (+/- SD) was similar in the standardized and nonstandardized groups (1.60 +/- 0.72 mm versus 1.64 +/- 0.85 mm), and the correlation was high (r = 0.95). Periodontitis was defined as present if the participant had at least one site with 3, 4 and 5 mm bone loss. The Kappa statistics for concordance using these three cutoffs were good and ranged from 0.60 to 0.65. The sensitivity ranged from 72.7 to 80.8% and specificity from 88.5 to 90.9%. CONCLUSIONS: Periodontitis assessed as mean alveolar bone loss or the prevalence of disease based on alveolar bone loss can be accurately and reliably evaluated from nonstandardized radiographs.

Adult↗
PubMed2004

Problems in exposure assessment of fluoride in drinking water.

OBJECTIVES: We developed a source documentation approach that identified fluoride content of drinking water at the state or local level to estimate fluoride concentrations from public water systems. We then compared estimates from this approach with estimates obtained from a single source, the 1992 Centers for Disease Control and Prevention (CDC) Fluoridation Census. METHODS: We used residential histories from a case-control study. For each residence we attempted to determine fluoride concentrations using the 1992 CDC Fluoridation Census. For the source documentation method we utilized multiple sources from state and local contacts to verify and collect additional data. We compared the fluoride estimates obtained by the two methods. RESULTS: When fluoride values were found using both methods, there was good correlation (Kendall's tau = 0.85; 95% confidence interval = 0.79, 0.90) and concordance was 96 percent. We obtained over 99 percent of the fluoride values needed using source documentation as compared to 49 percent of the values needed when we used a single publication. When fluoride values were missing using the 1992 CDC Fluoridation Census, 21 percent had source documentation estimates of at least 0.7 ppm. CONCLUSIONS: Researchers need to consider limitations of using a secondary data source to estimate fluoride in drinking water, particularly in studies where exposure to fluoride is the primary exposure of interest.

Cariostatic Agents↗
PubMed2003

Increased physical activity decreases periodontitis risk in men.

BACKGROUND: Increased physical activity improves insulin sensitivity and glucose metabolism, and may therefore affect incidence of periodontitis. METHODS: We studied the association of physical activity, walking and periodontitis in 39,461 male, US based, health professionals, 40-75 years old at baseline, more than half of whom were dentists, being followed up continuously since 1986. Participants were free of periodontitis, coronary heart disease and stroke at the start of follow-up. Physical activity and periodontitis were measured by validated questionnaires (expressed in metabolic equivalents--METs); the first report of professionally diagnosed periodontitis was considered a case. RESULTS: Periodontitis risk decreased by 3% for every 10-MET increase in average physical activity after adjustment for age, smoking, diabetes, BMI, alcohol consumption and total calories (RR = 0.97; 95% CI: 0.95-0.99). The inverse trend remained significant in the categorical analysis. Compared to men in the lowest quintile of physical activity, those in the highest quintile had a 13% lower risk of periodontitis (RR = 0.87; 95% CI: 0.76-1.01, p-value, test for trend = 0.02). In a sub-sample of men with radiographs (n = 137) the physically active had less average bone loss (beta = -0.29, p-value = 0.03) after multivariate adjustment compared to those inactive. CONCLUSIONS: In this large-scale prospective study, we found an inverse, linear association between sustained physical activity and periodontitis independent of known risk factors. The benefits of a physically active lifestyle may extend to periodontal health.

Adult↗
PubMed2003

A prospective study of social support, anger expression and risk of periodontitis in men.

BACKGROUND: Stress is associated with poor oral hygiene, increased glucocorticoid secretion that can depress immune function, increased insulin resistance and potentially increased risk of periodontitis. METHODS: The authors examined the association between social support, anger expression and periodontitis in 42,523 male, U.S.-based, health professionals. Subjects were aged 40 to 75 years in 1986, and more than half were dentists. The men were free of a diagnosis of periodontitis at the start of follow-up in 1996. RESULTS: Subjects who reported having at least one close friend had a 30 percent lower risk of developing periodontitis compared with those who did not have a close friend (relative risk, or RR = 0.70; 95 percent confidence interval, or CI, 0.51-0.96). Men who participated in religious meetings or services had a 27 percent lower risk of developing periodontitis compared with men who did not participate in religious meetings (RR = 0.73; 95 percent CI, 0.64-0.83). After the authors adjusted for potential confounding variables, men whose anger scores were in the top quintile were 72 percent more likely to report having periodontitis compared with men whose scores were in the lowest quintile (RR = 1.72; 95 percent CI, 1.39-2.12). Men who reported being angry on a daily basis had a 43 percent higher risk of developing periodontitis compared with men who reported being angry seldom. CONCLUSION: Reduced social isolation and anger expression may play an important role in maintaining oral health, as well as general health and well-being. CLINICAL IMPLICATIONS: When treating patients with periodontitis, clinicians should be cognizant of the social and behavioral factors that may affect oral health.

Adult↗
PubMed2002

Interaction between a single nucleotide polymorphism in the alcohol dehydrogenase 3 gene, alcohol consumption and oral cancer risk.

We investigated effects on oral cancer (OC) risk of an interaction between a single nucleotide polymorphism (SNP) in the alcohol dehydrogenase 3 (ADH3) gene and alcohol consumption levels using a hospital-based study of 93 cases and 99 controls conducted in Athens, Greece. This SNP affects ethanol metabolism in vitro and appeared to interact with alcohol consumption in a previous OC study. We also evaluated a SNP in CYP2E1, another gene involved in ethanol metabolism, reported to be associated with OC risk in a European population. Data on genotypes and risk factors obtained from interviews were analyzed using multivariate logistic regression, accounting for potential confounders. No overall (marginal) association was found between OC risk and ADH3 genotypes. An interaction between ADH3 genotypes and alcohol consumption levels, however, was suggested. In non-drinkers, the ADH3(1-1) genotype has higher risk than ADH3(1-2) or ADH3(2-2) genotypes, but for subjects consuming alcohol, lower risk was observed for ADH3. We fit a logistic regression model to estimate the increase in OC risk associated with each alcohol drink consumed per week. We estimated that OC risk increased by 31.5% per drink/week for the ADH3(2-2) genotype, 4.1% for the ADH3(1-2) genotype and 1.6% for the ADH3(1-1) genotype. Evidence of genotype-environment interaction was suggestive (p = 0.048, Wald chi p = 0.145, likelihood ratio). This finding is opposite to that reported for a population in Puerto Rico, where the ADH3(1-1) genotype seemed more sensitive to ethanol exposure. In Greece, genetic variation at the CYP2E1 SNP is almost entirely absent, with only 1 case and 1 control heterozygous for the variant. By contrast, in a population in France where an OC association was reported, the frequency of CYP2E1 heterozygotes was 5% in controls and 9% in OC cases. These findings illustrate the importance of replicating SNP associations both within and between different racial and ethnic groups and geographic regions.

Alcohol Dehydrogenase↗
PubMed2002

Nutrition as a mediator in the relation between oral and systemic disease: associations between specific measures of adult oral health and nutrition outcomes.

Recent associations between oral health and systemic disease have led to renewed interest in the mouth and its contribution to health outcomes. Many pathways for this relationship have been postulated, among them the potential mediating role of nutrition. The link between various nutrients and systemic disease has been established, but relatively little work has been done in relating oral conditions with nutrition. We searched MEDLINE, from 1966 to July, 2001, to identify articles relating specific oral measures to nutrition outcomes. We included original articles written in English with a sample size greater than 30 that used objective oral health measures. We reviewed a total of 56 articles. Only a small proportion of these studies were methodologically sound. Although many studies were small and cross-sectional, the literature suggests that tooth loss affects dietary quality and nutrient intake in a manner that may increase the risk for several systemic diseases. The impact of tooth loss on diet may be only partially compensated for by prostheses. To date, there is little information relating periodontal disease and oral pain and nutrition. A few studies suggest poorer nutrition among individuals with xerostomia and altered taste. Further, impaired dentition may contribute to weight change, depending on age and other population characteristics. There is a paucity of well-designed studies addressing oral health and nutrition. Before we can acquire a better understanding of how nutrition and oral health interrelate, however, more studies will be required to confirm these associations-preferably longitudinal studies with larger sample sizes and better control of important confounders.

Adult↗
PubMed2002

The relationship between oral conditions and ischemic stroke and peripheral vascular disease.

BACKGROUND: This article is a critical review of the epidemiologic studies linking or disassociating oral conditions with stroke and peripheral vascular disease, or PVD. It also describes possible causal and non-causal pathways for these associations. TYPES OF STUDIES REVIEWED: The author reviewed studies that evaluated the oral conditions of periodontal disease or tooth loss as risk factors for arterial disease and stroke. RESULTS: Seven of nine studies evaluating tooth loss and periodontal disease as risk factors for stroke or PVD showed some significant associations. The studies varied in the exposures and outcomes evaluated; therefore, the associations were not consistently replicated. It is unclear whether the associations found between these oral conditions and cardiovascular disease had any causal component. In the absence of any causal relationship, the associations may be explained by common risk factors. Alternatively, there may be a causal relationship that may be explained by one or more potential causal pathways. Further epidemiologic studies are needed, and the role of nutrition and other inflammatory mediators needs to be explored further in this context. CLINICAL IMPLICATIONS: It is recommended that clinicians continue to provide standard professional care, as well as nutritional counseling to help patients maintain a healthy diet after extractions. Clinicians are cautioned against suggesting extractions as a means of preventing cardiovascular disease.

Humans↗
PubMed2002

Oral hygiene practices and periodontitis in health care professionals.

BACKGROUND: One in 3 adults in the United States has periodontitis, yet there are few widely applied methods for its prevention. Few studies have assessed oral hygiene practices related to periodontitis. METHODS: There were 533 participants in this study (14.8% male dentists; 13.7% male non-dentist health care professionals; and 71.5% female nurses), all of whom are enrolled in ongoing cohort studies in the United States which have inquired about their oral hygiene practices and whether they have professionally diagnosed periodontitis. We studied the relationship between oral hygiene practices and periodontitis, controlling for potential confounders. RESULTS: The participants were 69 years old on average, 84.2% white, 12.4% current smokers, and 8.3% diabetic. Seventy percent of the dentists and nurses brushed at least twice a day compared to 56% of the other health professionals. Two-thirds of the nurses, 56.3% dentists, and 36.4% other health professionals flossed at least once daily. Persons brushing twice daily were as likely to have periodontitis as those brushing once or less daily (odds ratio [OR] = 1.16; 95% confidence interval [CI]: 0.64 to 2.10); persons flossing less than once a day were as likely to have periodontitis as those who flossed daily (OR = 1.16, 95% CI: 0.63 to 2.13) after controlling for profession, age, gender, smoking, diabetes, coronary heart disease, history of periodontal surgery, and number of teeth present. CONCLUSIONS: People who reported better oral hygiene practices did not report less periodontitis, after controlling for potential confounders. Oral hygiene practices were not associated with periodontitis in this population.

Age Factors↗