|Year : 2020 | Volume
| Issue : 3 | Page : 176-181
Periodontal status of 33–44-year-old male bodybuilders and its relationship with protein supplement intake: An observational comparative study
Fawaz Pullishery1, Abdulrahman Mohammed Dada2, Mohammed Roshdy Aboelaza3, Mohamed Abdelmegid Shalaby4
1 Department of Community Dental Practice and Research, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia
2 Dental Intern, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia
3 Department of Peridontology, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia
4 Department of Oral and Maxillofacial Surgery, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia
|Date of Submission||17-Jul-2020|
|Date of Decision||11-Aug-2020|
|Date of Acceptance||19-Aug-2020|
|Date of Web Publication||22-Sep-2020|
Department of Community Dental Practice, Batterjee Medical College, Jeddah
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: Periodontal disease is a highly prevalent oral disease that affects more than half of the global adult population. The role of protein supplements (PSs) in bodybuilding has been studied extensively, but there are no studies done that assessed periodontal health and its relationship of protein intake among bodybuilders. This study aims to assess the periodontal status in 35–44-year-old bodybuilders in the Kingdom of Saudi Arabia. Materials and Methods: A cross-sectional comparative study was conducted in the city of Jeddah among 35–44-year-old male bodybuilders and non-bodybuilders. Bodybuilders were identified and recruited from different fitness and gymnasium centres that satisfied the inclusion criteria. A pre-tested and validated questionnaire was used for collecting the information. Periodontal status was assessed using the Community Periodontal Index (CPI) and loss of attachment (LOA). Results: The CPI scores were comparatively lesser (11.34 ± 4.6) in bodybuilders than non-bodybuilders and it was statistically significant (P < 0.05). There were no significant differences in CPI scores between tobacco users and non-users among bodybuilders. The prevalence of periodontal pockets of 4–5 mm in non-body builders was 80.7% and in bodybuilders, it was 49.1% (odds ratio = 4.33 (1.865–10.085), P < 0.001). A positive correlation was observed between average PSs intake and periodontal pocket of 4–5 mm (r = 0.335, P < 0.05); frequency of PS intake and 4–5 mm pockets (r = 0.494, P < 0.001); duration of PS (r = 0.438, P < 0.001). Conclusion: The periodontal health was significantly better in bodybuilders despite the smoking status, and this cannot be only attributed to PS intake. There could be a relationship with protein intake, but there is a need for wider interventional studies in a prospective manner.
Keywords: Diet, lifestyle, periodontitis, protein, smoking
|How to cite this article:|
Pullishery F, Dada AM, Aboelaza MR, Shalaby MA. Periodontal status of 33–44-year-old male bodybuilders and its relationship with protein supplement intake: An observational comparative study. Adv Hum Biol 2020;10:176-81
|How to cite this URL:|
Pullishery F, Dada AM, Aboelaza MR, Shalaby MA. Periodontal status of 33–44-year-old male bodybuilders and its relationship with protein supplement intake: An observational comparative study. Adv Hum Biol [serial online] 2020 [cited 2021 Feb 24];10:176-81. Available from: https://www.aihbonline.com/text.asp?2020/10/3/176/295837
| Introduction|| |
Periodontal disease is a highly prevalent oral disease that affects more than half of the global adult population., Studies have shown that many risk factors are associated with periodontal diseases, which are either inherited or acquired., Identifying the modifiable risk factors could play a key role in both preventing and managing periodontal disease. Physical fitness enhances general health, thereby improving the quality of life and longevity. In the pursuit of increased muscular mass, strength and endurance bodybuilding has become popular among men that need to be festooned with an ideal nutritional programme.,
Nutrition has a key role to play in fitness as it helps to achieve the desired body mass and composition. Studies reported that the people who are involved in physical activity have a lower risk of periodontal diseases.,, On the contrary, reduced levels of physical activity and consumption of unhealthy diet have shown an increased incidence of periodontal diseases. Nutrients, both micro, and macro have an important role to play in periodontal health. Proteins are one of the macronutrients that are required in larger quantities and thus may have an inverse relationship with periodontal diseases.,
The role of protein supplements (PS) in bodybuilding has been studied extensively, but there is a lack of evidence for the relationship of PS with periodontal status among the same population. Hence, the principle aim of this study is to assess the periodontal status in 35–44-year-old bodybuilders in the kingdom of Saudi Arabia. The secondary objectives were to explore any possible relationship between PS intake, smoking status and oral hygiene practices with periodontal status in bodybuilders and non-body builders.
| Materials and Methods|| |
The Research and Ethics Committee of the institution approved this study (Approval Id: RES-2019-0036). A cross-sectional comparative study was conducted in the city of Jeddah among 35–44-year-old male bodybuilders and non-bodybuilders. Bodybuilders were identified and recruited from different fitness and gymnasium centres that satisfied the inclusion criteria.
- Current male bodybuilders aged between 35 and 44-years old who are doing bodybuilding for at least 5 years or more
- Bodybuilders who belonged to advanced bodybuilding only (as identified by experienced trainers)
- The comparison group included males aged between 35 and 44 years who have not tried bodybuilding ever (non-body builders)
- Individuals with ≥20 teeth in the oral cavity
- Those who gave consent to participate.
- An individual with any systemic diseases and/or history of usage of antibiotics, anticonvulsants, (phenytoin sodium, phenobarbital, lamotrigine, vigabatrin, ethosuximide, topiramate, and primidone), calcium channel blockers (antihypertensives such as nifedipine, amlodipine and verapamil), cyclosporine, etc., will be excluded from the study
- Those who have undergone periodontal therapy within the previous 1 year and those who were undergoing or underwent (or completed) orthodontic therapy within the past 2 years
- Beginners and intermediate bodybuilders.
A pre-tested and validated questionnaire was used for collecting the information. The first section (Part A) includes data related to the socio-demographic characteristics; details related to personal habits such as smoking, oral hygiene practices, dietary pattern including information on PSs intake; the third part consist of data related to bodybuilding such as duration, frequency and type of body. A single calibrated investigator (AD) recorded the socio-demographic and other characteristics of the participants (Part A and B). Another single examiner (MR) who is an experienced Periodontist recorded the periodontal status using Modified Community Periodontal Index (CPI) and loss of attachment (LOA) by Cutress et al. The periodontal measurement will be recorded at six sites per tooth (mesiobuccal, mid buccal, distobuccal, distolingual, mid lingual and mesiolingual) using and community periodontal index of treatment needs C probe.
A minimum sample size of 41 was calculated for each group considering the values from a previous study done by Aral et al. using the formula: N= (Z2 X S2)/d2, where Z = Standard normal deviate (1.96 at 95% confidence interval), S = Sample standard deviation. After the initial screening, participants who satisfied our criteria were included for our analysis, thus giving a sample of 55 bodybuilders and 57 non-body builders.
Statistical analysis and data management
Data recorded were transferred into the MS Excel sheet and subjected to statistical analysis. We used the software SPSS ver. 23 (IBM Corp Inc. USA) for carrying out the statistical analysis. Descriptive statistics were used in the Wform of frequencies and percentages. Pearson's Chi-square test (X2) was used to find any relationship between categorical variables and spearman's correlation (rho) was used to find the relationship between continuous variables.
| Results|| |
In our analysis, we included a total of 112 participants that had 55 bodybuilders (Group BB) and 57 non-body builders (Group NB). The mean age of the participants was found to be 40.3 ± 3.43 years in Group BB and 40.19 ± 3.39 years. The mean weights were found to be 82.49 ± 4.48 Kgs and 83.0 ± 7.46 Kgs in Group BB and Group NB, respectively. The mean height in Group BB was 176.20 ± 2.46 and that of Group NB was 177.33 ± 2.76. The socio-demographic details of the participants are depicted in [Table 1].
The CPI scores were comparatively lesser (11.34 ± 4.6) in bodybuilders than non-bodybuilders and it was statistically significant (P < 0.05). The LOA scores did not show any significant differences between the two groups [Table 2]. When the same scores were compared between tobacco and non-tobacco users in bodybuilders alone, it was found that there were no significant differences in CPI scores, but there were statistically significant differences observed in LOA scores (P < 0.001) [Table 3].
|Table 2: Comparison of Community Periodontal Index and loss of attachment score scores between bodybuilders and non-bodybuilders (n=112)|
Click here to view
|Table 3: Comparison of community periodontal index and loss of attachment scores between tobacco users and non-users in bodybuilders (n=55)|
Click here to view
When the periodontal statuses of two groups were compared it was found that there were no significant differences in bleeding scores (odds ratio [OR] 0.798 [0.379–1.685], P < 0.05). The calculus score was comparatively more in bodybuilders than the non-building group (P < 0.001). The prevalence of periodontal pockets of 4–5 mm in non-body builders was 80.7% and in body-builders, it was 49.1% (OR = 4.33 [1.865–10.085], P < 0.001). There was no statistically significant difference noted in the prevalence of pockets of 6 mm or more between two groups (OR = 1.510 [0.587–3.885], P > 0.05) [Table 4].
The prevalence of tobacco usage in bodybuilders was found to be 27.27% and when the relationship of tobacco usage with periodontal status was measured, it was found that there was statistically significant association observed except with bleeding scores. Bleeding prevalence was more observed in non-tobacco users than users among bodybuilders (P < 0.001) [Table 5].
|Table 5: Relationship between periodontal status and tobacco use in body builders (n=55)|
Click here to view
We also assessed the relationship of the protein intake with the periodontal status in bodybuilders. There was a negative correlation observed between calculus scores and average PSs (r = −0.298, P < 0.05), frequency of PSs intake (r = −0.471, P < 0.001) and duration (r = −0.394, P < 0.05). A positive correlation was observed between average PS intake and periodontal pocket of 4–5 mm (r = 0.335, P < 0.05); frequency of PS intake and 4–5 mm pockets (r = 0.494, P < 0.001); duration of PS (r = 0.438, P < 0.001). There was also a positive correlation observed between the frequency of PS and pockets of 6 mm or more (r = 0.300, P < 0.05); between the duration of PS and pockets of 6 mm or more (r = 0.268, P < 0.05) [Table 6]. When a partial correlation analysis was performed between periodontal status and protein intake after controlling the smoking status, it was found that there was no negative correlation observed with the same [Table 7].
|Table 6: Correlation between protein intake and periodontal status in bodybuilders (n=55)|
Click here to view
|Table 7: Partial correlation between periodontal status and protein intake after adjusting tobacco use among bodybuilder (n=55)|
Click here to view
| Discussion|| |
The current study was an attempt to assess the status of the periodontium in 33–44 years bodybuilders considering the effect of PSs on it. We selected the age group of 33–44 years, as this was the recommended age group for surveillance of oral health conditions in adults by the World Health Organisation. There were no studies done in Middle East countries that assessed the periodontal status among bodybuilders. The findings of our study showed that periodontal status was comparatively better among bodybuilders than non-builders. There were statistically significant differences in CPI scores between bodybuilders and non-builders, even if there was no difference observed in the same between tobacco users and non-tobacco users. Physical activity could have a health benefit on periodontal health as it is well accepted that many systemic diseases such as type II diabetes and coronary heart diseases which are risk factors for periodontitis, have shown reduced incidence among people who perform some form of exercises., Bodybuilders are people who are involved in heavy physical activity and weightlifting; thus, our findings support the evidence that periodontal status is better among this population than those who are not involved in bodybuilding.
It is also reported that increased levels of inflammatory mediator prostaglandin (PGE2) and C-reactive protein causes gingival and periodontal destruction., Evidence show that people who are involved in regular physical activity have shown reduced levels of these biomarkers and this could be attributed to the reduced incidence of periodontitis in this population.,, Our study findings showed that the periodontal attachment loss (LOA) was observed to be more among bodybuilders who used tobacco in any form than those who did not. It is well documented that tobacco is a risk factor for periodontal destruction and our findings support this evidence., It is reported that smoking reduces the skeletal muscle strength by impairing the muscle protein synthesis (increases the expression of myostatin and MAFbx genes) and this may have an effect on the periodontal health of bodybuilders.,
In our study, we did not find any inverse relationship between protein intake and the periodontitis even after the tobacco usage was adjusted. A study done in the Danish adult population has reported an inverse relationship between protein intake and periodontitis. There are no studies done on bodybuilders that tested the effect of PSs on periodontal status. Some animal studies showed that a high protein-rich diet increased the alveolar bone thickness and also showed recovery from ligature induced bone resorption., The relationship of a high protein diet on skeletal muscle hypertrophy in bodybuilders is well established, but how the same can contribute to positive health benefits on periodontal tissue is rarely studied. It has been reported that whey protein may prevent alveolar bone loss by increasing the serum level of heterocyclic protein amino acids such as hydroxyproline.
Even though randomised controlled trials (RCTs) are the best studies to draw a causal relationship between dietary intake and health outcomes, it is often difficult to conduct RCTs when you need to study disease risk over the years or decade of chronic exposure of certain dietary components. Our study was a cross-sectional study; hence, the findings should be interpreted with the limitations that commonly encountered in observational dietary studies. There are numerous confounding factors that cannot be controlled when studying the effect of diet on a certain disease. Biological differences, food metabolism (absorption and utilization), dietary pattern, type and content of PSs, drug usage (steroids or other hormone supplements), oral hygiene practices, intensity of exercises are some of the factors that were not controlled in our study that are reported to have some effects on periodontal health.,,,, The possibility of recall bias is also huge when reporting tobacco usage, bodybuilding status and dietary protein intake, etc., All these limitations and factors should be considered before generalising our study findings, as this was an initial attempt to assess the effect of protein intake and bodybuilding on periodontal health. Researchers can think of conducting experimental or observational prospective studies after controlling some factors that may have a confounding effect when studying the relationship between dietary protein intake and periodontal health.
| Conclusion|| |
Our findings show that periodontal health was comparatively better in bodybuilders than their counterparts. Even though the community periodontal scores showed statistically significant differences between bodybuilders and non-bodybuilders there were no statistical differences observed in LOA scores. Tobacco usage (smoking) did not show any statistical differences in periodontal scores among bodybuilders. The cause of periodontal diseases is multi-factorial and more analytical prospective studies are required to test the relationship of dietary protein intake with periodontal health.
All the authors would like to express their deep gratitude and thanks to all the participants and staff of Gold Gym, Body Masters and Fitness Time, Jeddah, Saudi Arabia, for extending their full support and co-operation for this research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Benjamin RM. Oral health: The silent epidemic. Public Health Rep 2010;125:158-9.
Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ. Periodontitis in US adults: National health and nutrition examination survey 2009-2014. J Am Dent Assoc 2018;149:576-880.
Van Dyke TE, Sheilesh D. Risk factors for periodontitis. J Int Acad Periodontol 2005;7:3-7.
AlJehani YA. Risk factors of periodontal disease: Review of the literature. Int J Dent 2014;2014:182513.
Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al
. Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007;39:1423-34.
Mosley PE. Bigorexia: Bodybuilding and muscle dysmorphia. Eur Eat Disord Rev 2009;17:191-8.
Ali MS, Batley H, Ahmed F. Bodybuilding supplementation and tooth decay. Br Dent J 2015;219:35-9.
Hughes D. Nutrition and fitness: Mental health, ageing, and the implementation of a healthy diet and physical activity lifestyle. Br J Sports Med 2006;40:951.
Al-Zahrani MS, Borawski EA, Bissada NF. Increased physical activity reduces prevalence of periodontitis. J Dent 2005;33:703-10.
Joshipura K. Exercise, high-quality diet, and maintaining normal weight are associated with reduced levels of periodontitis. J Evid Based Dent Pract 2006;6:230-1.
Merchant AT, Pitiphat W, Rimm EB, Joshipura K. Increased physical activity decreases periodontitis risk in men. Eur J Epidemiol 2003;18:891-8.
Bawadi HA, Khader YS, Haroun TF, Al-Omari M, Tayyem RF. The association between periodontal disease, physical activity and healthy diet among adults in Jordan. J Periodontal Res 2011;46:74-81.
Antonoglou GN, Knuuttila M, Niemelä O, Raunio T, Karttunen R, Vainio O, et al
. Low serum level of 1,25(OH)2 D is associated with chronic periodontitis. J Periodontal Res 2015;50:274-80.
Adegboye AR, Boucher BJ, Kongstad J, Fiehn NE, Christensen LB, Heitmann BL. Calcium, vitamin D, casein and whey protein intakes and periodontitis among Danish adults. Public Health Nutr 2016;19:503-10.
Cutress TW, Ainamo J, Sardo-Infirri J. The community periodontal index of treatment needs (CPITN) procedure for population groups and individuals. Int Dent J 1987;37:222-33.
Aral K, Berdeli E, Aral CA, Berdeli A, Atan M. Effects of bodybuilding and protein supplements in saliva, gingival crevicular fluid, and serum. J Oral Sci 2017;59:121-30.
U.S. Department of Health and Human Services. Physical Activity and Health: Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, National Center for Chronic Disease Prevention and Health Promotion; 1996. Available from: http://www.surgeongeneral.gov/library/reports.htm
. [Last acessed on 2022 Jan 12].
Winzer EB, Woitek F, Linke A. Physical Activity in the Prevention and Treatment of Coronary Artery Disease. J Am Heart Assoc. 2018;7:e007725.
Båge T, Kats A, Lopez BS, Morgan G, Nilsson G, Burt I, et al
. Expression of prostaglandin E synthases in periodontitis immunolocalization and cellular regulation. Am J Pathol 2011;178:1676-88.
Bansal T, Pandey A, Dhruvakumar D, Asthana AK. C-Reactive Protein (CRP) and its Association with Periodontal Disease: A Brief Review. J Clin Diagn Res. 2014;8:ZE21-ZE24.
Abramson JL, Vaccarino V. Relationship between physical activity and inflammation among apparently healthy middle-aged and older US adults. Arch Intern Med 2002;162:1286-92.
Scientific Program Committee. Physical activity across the cancer continuum: Report of a workshop: Review of existing knowledge and innovative designs for future research. Cancer 2002;95:1134-43.
Ford ES. Does exercise reduce inflammation? Physical activity and C-reactive protein among U.S. adults. Epidemiology 2002;13:561-8.
Leite FR, Nascimento GG, Scheutz F, López R. Effect of smoking on periodontitis: A systematic review and meta-regression. Am J Prev Med 2018;54:831-41.
Leite FR, Nascimento GG, Baake S, Pedersen LD, Scheutz F, López R. Impact of smoking cessation on periodontitis: A systematic review and meta-analysis of prospective longitudinal observational and interventional studies. Nicotine Tob Res 2019;21:1600-8.
Saito T, Miyatake N, Sakano N, Oda K, Katayama A, Nishii K, et al
. Relationship between cigarette smoking and muscle strength in Japanese men. J Prev Med Public Health 2012;45:381-6.
Petersen AM, Magkos F, Atherton P, Selby A, Smith K, Rennie MJ, et al
. Smoking impairs muscle protein synthesis and increases the expression of myostatin and MAFbx in muscle. Am J Physiol Endocrinol Metab 2007;293:E843-8.
Seto H, Toba Y, Takada Y, Kawakami H, Ohba H, Hama H, et al
. Milk basic protein increases alveolar bone formation in rat experimental periodontitis. J Periodontal Res 2007;42:85-9.
Breivik T, Gundersen Y, Fonnum F, Vaagenes P, Opstad PK. Chronic glycine treatment inhibits ligature-induced periodontal disease in Wistar rats. J Periodontal Res 2005;40:43-7.
Phillips SM. A brief review of critical processes in exercise-induced muscular hypertrophy. Sports Med 2014;44 Suppl 1:S71-7.
Shah FA, Sayardoust S, Thomsen P, Palmquist A. Extracellular matrix composition during bone regeneration in the human dental alveolar socket. Bone 2019;127:244-9.
Maki KC, Slavin JL, Rains TM, Kris-Etherton PM. Limitations of observational evidence: Implications for evidence-based dietary recommendations. Adv Nutr 2014;5:7-15.
Yeo R, Yoon SR, Kim OY. The association between food group consumption patterns and early metabolic syndrome risk in non-diabetic healthy people. Clin Nutr Res 2017;6:172-82.
Jackson M, Marks L, May GHW, Wilson JB. The genetic basis of disease. Essays Biochem 2018;62:643-723.
Alshammari SA, AlShowair MA, AlRuhaim A. Use of hormones and nutritional supplements among gyms' attendees in Riyadh. J Family Community Med 2017;24:6-12.
Güncü GN, Tözüm TF, Caǧlayan F. Effects of endogenous sex hormones on the periodontium-review of literature. Aust Dent J 2005;50:138-45.
Lertpimonchai A, Rattanasiri S, Arj-Ong Vallibhakara S, Attia J, Thakkinstian A. The association between oral hygiene and periodontitis: A systematic review and meta-analysis. Int Dent J 2017;67:332-43.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]