title: Docosahexaenoic Acid and Periodontitis in Adults: A Randomized Controlled Trial.
abstract: Periodontitis is a common chronic inflammatory disease initiated by bacteria, resulting in bone resorption, tooth loss, and systemic inflammation. Long-chain omega-3 fatty acids such as docosahexaenoic acid (DHA) reduce periodontitis in animals. We aimed to determine whether DHA supplementation with low-dose aspirin would reduce periodontitis in humans. We conducted a double-blind placebo-controlled parallel trial lasting 3 mo. Fifty-five adults with moderate periodontitis were randomized to 2,000 mg of DHA or identical soy/corn oil capsules. All participants received 81 mg of aspirin but received no other treatments. We analyzed the primary outcome of per-pocket change in pocket depth using mixed models among teeth with pocket depth ≥5 mm. Secondary outcomes assessed with generalized estimating equations included gingival index, plaque index, and bleeding on probing. Gingival crevicular fluid samples were analyzed for changes in high-sensitivity C-reactive protein (hsCRP) and interleukins 6 and 1β (IL-6 and IL-1β). Plasma was analyzed for changes in systemic inflammatory markers, including hsCRP. We confirmed adherence with erythrocyte fatty acid measurement. Forty-six participants completed the trial. While similar at baseline, the proportion of DHA in red blood cell plasma membranes increased from 3.6% ± 0.9% to 6.2% ± 1.6% in the intervention group but did not change among controls. DHA supplementation decreased mean pocket depth (-0.29 ± 0.13; p = .03) and gingival index (-0.26 ± 0.13; p = .04). Plaque index and bleeding on probing did not change. Significant adjusted differences were found between DHA and control for both gingival crevicular fluid hsCRP (-5.3 ng/mL, standard error [SE] = 2.4, p = .03) and IL-1β (-20.1 pg/mL, SE = 8.2, p = .02) but not IL-6 (0.02 pg/mL, SE = 0.71, p = .98) or systemic hsCRP (-1.19 mg/L, SE = 0.90, p = .20). In this randomized controlled trial, aspirin-triggered DHA supplementation significantly improved periodontal outcomes in people with periodontitis, indicating its potential therapeutic efficacy (clinicaltrials.gov NCT01976806).
authors: Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard Medical School, Boston, MA, USA anaqvi@bidmc.harvard.edu.
authors: A Z
authors: AZ
authors: Naqvi
authors: Forsyth Institute, Cambridge, MA, USA.
authors: H
authors: H
authors: Hasturk
authors: Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors: L
authors: L
authors: Mu
authors: Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
authors: R S
authors: RS
authors: Phillips
authors: Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard School of Public Health, Boston, MA, USA.
authors: R B
authors: RB
authors: Davis
authors: Forsyth Institute, Cambridge, MA, USA Dentists Collaborative, North Andover, MA, USA.
authors: S
authors: S
authors: Halem
authors: Harvard School of Public Health, Boston, MA, USA.
authors: H
authors: H
authors: Campos
authors: Forsyth Institute, Cambridge, MA, USA.
authors: J M
authors: JM
authors: Goodson
authors: Forsyth Institute, Cambridge, MA, USA.
authors: T E
authors: TE
authors: Van Dyke
authors: Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard School of Public Health, Boston, MA, USA.
authors: K J
authors: KJ
authors: Mukamal
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000032:analysis / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D002097:C-Reactive Protein / Q000032:analysis; D002462:Cell Membrane / Q000737:chemistry; D003774:Dental Plaque Index; D004281:Docosahexaenoic Acids / Q000032:analysis / Q000627:therapeutic use*; D004311:Double-Blind Method; D004912:Erythrocytes / Q000737:chemistry; D005260:Female; D005500:Follow-Up Studies; D005883:Gingival Crevicular Fluid / Q000737:chemistry; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis / Q000097:blood; D053583:Interleukin-1beta / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis / Q000097:blood; D008297:Male; D008875:Middle Aged; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000517:prevention & control; D010518:Periodontitis / Q000097:blood / Q000517:prevention & control*; D010919:Placebos; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; C508600:IL6 protein, human; D018836:Inflammation Mediators; D053583:Interleukin-1beta; D015850:Interleukin-6; D010919:Placebos; D004281:Docosahexaenoic Acids; D002097:C-Reactive Protein; D001241:Aspirin
keywords: DHA; clinical study; fatty acid; gingivitis; inflammation; omega-3