대한치위생과학회지 (Journal of Korean Dental Hygiene Science)

대한치과위생학회 & 한국치위생과학회 (The Korean Academy of Dental Hygiene & The Korean Society of Dental Hygiene Science)
권호 표지
DOI QR코드

DOI QR Code

한국 성인의 우울증 여부에 따른 신체활동과 치주질환 간 관련성

Association between physical activity and periodontitis according to depression among Korean adults

  • 전혜림 (강릉원주대학교 치과대학 치위생학과) ;
  • 배수명 (강릉원주대학교 치과대학 치위생학과) ;
  • 이효진 (강릉원주대학교 치과대학 치위생학과)
  • Hye-Rim Jeon (Department of Dental Hygiene, College of Dentistry, Gangneung-Wonju National University) ;
  • Soo-Myoung Bae (Department of Dental Hygiene, College of Dentistry, Gangneung-Wonju National University) ;
  • Hyo-Jin Lee (Department of Dental Hygiene, College of Dentistry, Gangneung-Wonju National University)
  • 투고 : 2024.06.12
  • 심사 : 2024.06.27
  • 발행 : 2024.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

연구의 배경 및 목적: 본 연구는 한국 성인을 대표하는 표본을 대상으로 우울증에 따른 신체활동과 치주염의 연관성을 조사하고자 하였다. 한국 성인의 우울 증상에 따라 신체활동과 치주염 간 연관성에 차이가 있는지 파악하고자 하며, 이를 통하여 우울증 환자의 구강건강 증진 및 유지관리를 위하여 신체활동을 포함한 건강행동에 대한 기초자료를 제공하는데 근거가 되고자 한다. 연구 방법: 제7기 국민건강영양조사(2016~2018년)에 참여한 총 12,689명의 대상자를 조사하였다. 우울증은 PHQ-9 ≥ 10으로 정의했다. 치주 상태는 지역 사회 치주지수(CPI)를 사용하였다. 치주염은 코드 3 이상으로 설정했다. 구강검사는 조사지역 중 일부를 추출하여 검사를 진행하여 제 7기로 통합되어 별도 가중치가 사용되었다. 개별가중치 요인이 사용되었고, 자료 분석은 복합표본설계(Complex sampling design)를 통해 분산값을 계산했다. 신체활동은 일과 여가, 장소이동과 관련된 신체활동으로 구분되며, 본 연구에서는 일과 여가에서 약간 숨이 차거나 심장이 약간 빠르게 뛰는 활동 이상을 하는 경우와 장소이동 신체활동을 모두 포함하는 총신체활동량으로 정의하였다. 총신체활동량은 신체활동 실천 일수와 시간을 고려하여 강도에 따라 가중치를 부여하여 산출하였고, 산출된 값의 분포를 고려하여 총신체활동을 하는 집단과 하지 않는 집단으로 나누었다. 다변량 로지스틱회귀분석을 실시하고자, 사회인구학적 변수(연령, 성별, 교육수준 및 가구소득), 구강 및 건강행동(치실 및 치간칫솔 사용, 현재 흡연), 전신건강상태(당뇨병 및 고혈압) 변수를 보정하였다. 우울증 여부에 따라 층화분석을 실시하여 신체활동과 치주염 간 연관성 차이를 분석하였다. 결과: 다변수 로지스틱회귀모형에서 우울증이 있는 대상자 중 신체활동을 하지 않는 집단은 신체활동을 하는 집단보다 치주질환의 위험성이 2.65배(오즈비 = 2.65, 95% 신뢰구간 = 1.17-6.01) 높은 것으로 나타났다. 결론: 우울증이 있는 경우 신체활동은 치주염과 유의하게 관련이 있는 것으로 나타났다.

Background: This study aimed to investigate the association between physical activity and periodontitis based on depression status in a representative sample of Korean adults. Methods: A total of 12,689 subjects who participated in the 7th Korea National Health and Nutrition Examination Survey (2016-2018) were examined. Depression was defined as a PHQ-9 score ≥ 10. Periodontal status was assessed using the community periodontal index, with periodontitis defined as a code ≥ 3. Physical activity categories were divided into a physical activity group and a non-physical activity group, considering the number of days and minutes spent on moderate and vigorous activities. Moderate activity was defined as causing slight breathlessness or a slightly elevated heart rate, while vigorous activity was defined as causing significant breathlessness or a rapid heart rate. Multivariable logistic regression analyses were adjusted for sociodemographic variables (age, sex, education level, and household income), oral and general health behaviors (use of floss and interdental proximal brush, current smoking), and systemic health status (diabetes and hypertension). All analyses utilized a complex sampling design, and subgroup analysis was performed to estimate associations stratified by depression (PHQ-9 ≤ 9 and ≥ 10). Results: Multivariable regression analysis revealed that among participants with depression, those who did not engage in physical activity were 2.65 times more likely to have periodontitis (odds ratio = 2.65, 95% confidence interval = 1.17-6.01). Conclusion: The study findings suggest that individuals who participate in any form of physical activity may be significantly less likely to develop periodontitis, particularly within the group experiencing depression.

키워드

참고문헌

  1. Oppermann, RV, et al. Epidemiology of periodontal diseases in adults from Latin America. Periodontol 2000 2015;67(1):13-33. https://doi.org/10.1111/prd.12061
  2. Papapanou, PN, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and PeriImplant Diseases and Conditions. J Periodontol 2018;89Suppl1:S173-S182. https://doi.org/10.1002/JPER.17-0721
  3. Nico Geurs, et al. American Academy of Periodontology Task Force Report on the Update to the 1999 Classification of Periodontal Diseases and Conditions. J Periodontol 2015;86(7):835-838. https://doi.org/10.1902/jop.2015.157001
  4. Burt B, Research, Science and Therapy Committee of the American Academy of Periodontology. Position paper: epidemiology of periodontal diseases. J Periodontol 2015;76(8):1406-1419. https://doi.org/10.1902/jop.2005.76.8.1406
  5. Hajishengallis G, Chavakis T. Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities. Nat Rev Immunol 2021;21(7):426-440. https://doi.org/10.1038/s41577-020-00488-6
  6. Hajishengallis G. Interconnection of periodontal disease and comorbidities: Evidence, mechanisms, and implications. Periodontol 2000 2022;89(1):9-18. https://doi.org/10.1111/prd.12430
  7. Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2015;25Suppl3:1-72. https://doi.org/10.1111/sms.12581
  8. Malali E, et al. Levels of C-reactive protein and protein C in periodontitis patients with and without cardiovascular disease. Pathophysiol Haemost Thromb 2010;37(1):49-54. https://doi.org/10.1159/000318189
  9. Beck JD, et al. Periodontal profile class is associated with prevalent diabetes, coronary heart disease, stroke, and systemic markers of C-reactive protein and interleukin-6. J Periodontol 2018;.89(2):157-165. https://doi.org/10.1002/JPER.17-0426
  10. Sanders AE, et al. Physical activity, inflammatory biomarkers in gingival crevicular fluid and periodontitis. J Clin Periodontol 2009;36(5):388-395. https://doi.org/10.1111/j.1600-051X.2009.01394.x
  11. Al-Zahrani MS, et al. Increased physical activity reduces prevalence of periodontitis. J Dent 2005;33(9):703-710. https://doi.org/10.1016/j.jdent.2005.01.004
  12. Beck JS, Cognitive Therapy: Basics and Beyond. J Psychother Pract Res 1997;6(1):71-80.
  13. Vancampfort D, et al. What are the factors that influence physical activity participation in individuals with depression? A review of physical activity correlates from 59 studies. Psychiatria Danubina 2015;27(3): 210-224.
  14. Kim Jiu, Hwang Boyoung, Factors Related to Physical Activity in Midlife and Old Women with Depression. J Korean Acad Psychiatr Ment Health Nurs. 2022;31(2):254-263. https://doi.org/10.12934/jkpmhn.2022.31.2.254
  15. Skoskiewicz-Malinowska K, et al. Oral health condition and occurrence of depression in the elderly. Medicine 2018;97(41):e12490.
  16. Kang JY. The Relationship Depressive symptoms and Periodontal Disease in Korean Adults 2014 Korea National Health and Nutrition Examination Survey. Unpublished Master's thesis. Hanyang University, Seoul, 2017.
  17. Nascimento GG, et al. Is there an association between depression and periodontitis? A birth cohort study. J Clin Periodontol 2019;46(1):31-39. https://doi.org/10.1111/jcpe.13039
  18. Retrieved January 30, 2024, from http://www.hira.or.kr. 건강보험심사평가원, 최근 5년 (2017~2021년) 우울증과 불안장애 진료현황 분석.hwp(2022).
  19. Jung ES, et al. Association between oral health status and chronic obstructive pulmonary disease in Korean adults. Int Dent J 2020;70(3):208-213. https://doi.org/10.1111/idj.12535
  20. Choi, Hong Seok, et al. Standardization of the Korean Version of Patient Health Questionnaire-9 as a Screening Instrument for Major Depressive Disorder. J Korean Acad Fam Med 2007;28.2:114-119.
  21. Park SJ, et al. Reliability and validity of the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Anxiety and mood 2010;6(2):119-124.
  22. Teixeira, FB, et al. Periodontitis and Alzheimer's Disease: A Possible Comorbidity between Oral Chronic Inflammatory Condition and Neuroinflammation. Front Aging Neurosci 2017;9:327. https://doi.org/1 0.3389/fnagi.2017.00327 https://doi.org/10.3389/fnagi.2017.00327
  23. Potempa J, et al. The case for periodontitis in the pathogenesis of rheumatoid arthritis. Nat Rev Rheumatol 2017;13(10):606-620. https://doi.org/10.1038/nrrheum.2017.132
  24. Gleeson M, et al. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nat Rev Immunol 2011;11(9):607-615. https://doi.org/10.1038/nri3041
  25. Ferreira RO, et al. Physical Activity Reduces the Prevalence of Periodontal Disease: Systematic Review and Meta-Analysis. Front Physiol 2019;10:234. https://doi.org/10.3389/fphys.2019.00234
  26. Ferreira RO, et al.. Physical Activity Reduces the Prevalence of Periodontal Disease: Systematic Review and Meta-Analysis. Front Physiol 2019;10:234. https://doi.org/10.3389/fphys.2019.00234
  27. Bawadi HA, et al... The association between periodontal disease, physical activity and healthy diet among adults in Jordan. J Periodontal Res 2011;46(1):74-81. https://doi.org/10.1111/j.1600-0765.2010.01314.x
  28. Merchant AT, et al... Increased physical activity decreases periodontitis risk in men. Eur J Epidemiol 2003;18(9):891-898. https://doi.org/10.1023/a:1025622815579
  29. Weyerer S, Kupfer B. Physical exercise and psychological health. Sports Med 1994;17(2):108-116. https://doi.org/10.2165/00007256-199417020-00003
  30. Teychenne M., et al. Physical activity and likelihood of depression in adults: a review. Prev Med 2008;46(5): 397-411. https://doi.org/10.1016/j.ypmed.2008.01.009
  31. Thoren P, et al. Endorphins and exercise: physiological mechanisms and clinical implications. Med Sci Sports Exerc. 1990;22(4):417-428.
  32. Stewart AL, et al. Long-term functioning and well-being outcomes associated with physical activity and exercise in patients with chronic conditions in the Medical Outcomes Study. J Clin Epidemiol. 1994;47(7):719-730. https://doi.org/10.1016/0895-4356(94)90169-4
  33. Boyapati L, Wang HL. The role of stress in periodontal disease and wound healing. Periodontol 2000 2007;44:195-210. https://doi.org/10.1111/j.1600-0757.2007.00211.x
  34. Kurer JR, et al. Psychological mood of regular dental attenders in relation to oral hygiene behaviour and gingival health. J Clin Periodontol 1995;22(1):52-55. https://doi.org/10.1111/j.1600-051x.1995.tb01770.x
  35. Irwin M, et al. Reduction o f immune function in life stress and depression. Biol Psychiatry 1990;27(1):22-30. https://doi.org/10.1016/0006-3223(90)90016-u
  36. Kroenke K, et al. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
  37. Spitzer RL, et al. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999;282(18):1737-44. https://doi.org/10.1001/jama.282.18.1737
  38. Kim SR, Nam SH. Comparison of Diagnosed Depression and Self-Reported Depression Symptom as a Risk Factor of Periodontitis: Analysis of 2016-2018 Korean National Health and Nutrition Examination Survey Data. Int J Environ Res Public Health 2021;18(3):871. https://doi.org/10.3390/ijerph18030871