Research in Focus
NYU Dental Researchers Publish Findings on Link Between Childhood Malnutrition and Periodontal Disease in Haiti

Dr. Walter Psoter

Dr. Stefanie Russell

Dr. Yihong Li

Children waiting to provide saliva samples to NYUCD researchers.

Dr. Psoter with children in the study.

Teenagers who suffered from protein-energy malnutrition in early childhood may be at an increased risk of developing periodontal disease, according to recent findings published by NYU dental researchers. The researchers' studies were supported by a $1.6 million grant awarded to Dr. Walter Psoter, an Associate Professor in the Department of Epidemiology & Health Promotion, by the National Institute of Dental and Craniofacial Research, part of the NIH, in 2005, to support the first-ever study of the impact of early childhood protein malnutrition, or ECPEM, on oral health in Haiti, the Western Hemisphere's poorest country.

Protein-energy malnutrition occurs when there are deficiencies in protein and many other essential nutrients. When the malnutrition occurs in early childhood, it is believed to adversely affect the developing immune system, leading to an increased risk of infection that lasts long past childhood. Over one-third of the world's children are affected by ECPEM.

Haiti's childhood malnutrition rates, estimated at 40 to 75 percent, are among the highest in the world.

Joining Dr. Psoter on this study were his coinvestigators at NYU: Dr. Stefanie Russell, Assistant Professor of Epidemiology & Health Promotion; Dr. Yihong Li, Professor of Basic Science & Craniofacial Biology; Dr. Andrew I. Spielman, Professor of Basic Science & Craniofacial Biology; and Dr. Ralph Katz, Professor and Chair of the Department of Epidemiology & Health Promotion.

The NYU researchers conducted a series of studies comparing the oral health of adolescents with and without a history of ECPEM in more than a dozen rural villages in the Grand'Anse region of southern Haiti. The study subjects were identified from a database of height and weight measurements that the Haitian Health Foundation, a nonprofit group providing nutritional programs to the villages, gathered between 1988 and 1993, when the subjects were in their first five years of life.

The researchers traveled to Haiti in 2005 and 2006 to assess the oral health status of 1,017 children and adolescents, identified from the foundation's database, who still resided in the villages.

One study, led by Dr. Psoter, focused on possible links between ECPEM and the body's ability to fight oral infections such as caries and periodontal disease. The study sought to determine whether ECPEM might compromise the functioning of glandular systems, such as the salivary glands, which are essential to the healthy functioning of the immune system. Dr. Psoter's team examined all 1,017 children and adolescents, ages 11 to 19, and found that those who experienced ECPEM had significantly lower levels of both stimulated and unstimulated salivary flow compared to teens with no history of ECPEM.

"The findings suggest that glandular systems may be compromised for extended periods following early childhood malnutrition," explained Dr. Psoter, "which, in turn, may have important implications for the body's antimicrobial defenses against oral and systemic infections." Dr. Psoter published his findings in the March 2008 issue of Archives of Oral Biology. His coauthors included Dr. Andrew I. Spielman, Professor of Basic Science & Craniofacial Biology.

A second study, led by Dr. Russell, assessed whether there was a link between ECPEM and periodontal inflammation in a subgroup of 96 adolescents, ages 12 to 19. Dr. Russell found that those with a history of ECPEM had a higher degree of periodontal inflammation than subjects who were not malnourished as young children, and that ECPEM was significantly and directly related to periodontal treatment needs as measured by the Community Periodontal Index, an epidemiological screening protocol.

"Because ECPEM is likely to affect the developing immune system," explained Dr. Russell, "a person's ability to respond to colonization by periodontal pathogens may be adversely affected permanently." Dr. Russell published her findings in the May 2010 issue of the International Journal of Pediatric Dentistry.

A third study, led by Dr. Li, involved an analysis of bacterial samples from the gingiva of the same subgroup of 96 adolescents whom Dr. Russell examined. Dr. Li found that 85 percent of teens with a history of ECPEM had signs of colonization by Aggregatibacter actinomycetemcomitans, one of the bacteria most commonly associated with periodontal disease.

"The high prevalence of this bacterium may serve as a risk indicator for future initiation of periodontal disease in rural Haitian adolescents," said Dr. Li, who published her findings in the May 6, 2010, online edition of Clinical Oral Investigations.

According to Dr. Psoter, additional research is needed to determine whether the links between ECPEM, salivary flow, and periodontal disease that were observed in the three studies can be generalized to adolescents residing in underdeveloped areas in other parts of the world where malnutrition is common. He added that future research should focus on uncovering possible connections between ECPEM and systemic as well as oral infections.

Meanwhile, the earthquake that struck Haiti last January has complicated efforts by aid groups to address chronic malnutrition in Grand'Anse, the rural region where the NYU researchers collected their samples. It is estimated that 100,000 people migrated to Grand'Anse from Haiti's quake-ravaged capital, Port-au-Prince, putting a strain on nutritional programs serving residents there.

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