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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 30  |  Issue : 2  |  Page : 102-106

Estimation of serum lipid profile in patients with OSMF


Department of Oral Medicine and Radiology, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, India

Date of Submission09-Jul-2017
Date of Acceptance01-Mar-2018
Date of Web Publication16-Jul-2018

Correspondence Address:
Dr. Anuj Mishra
Department of Oral Medicine and Radiology, Sardar Patel Campus, Uthrethia, Raibarelly Road, Lucknow
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.JIAOMR_21_17

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   Abstract 


Aim: This study was done to evaluate the alteration in serum lipid profile pattern in patients with oral submucous fibrosis, with various histological grades of Oral Sub Mucous Fibrosis along with controls. Materials and Methods: The study included 150 participants, out of those 120 were having oral submucous fibrosis, and 30 cases of controls matched for age and sex were selected from the routine patients attending the Department of Oral Medicine and Radiology. Serum lipids, including total cholesterol (TC), LDL cholesterol (LDLC), HDL cholesterol (HDLC), VLDL cholesterol (VLDLC), and triglycerides (TG) were analyzed using kit ACCUREX [Bio-medicals limited, India] as per the instructions provided by manufacturer using SEMI AUTO ANALYSER [Tulip Coral 3000 Indian]. Statistical Analysis Used: Data were summarized as Mean ± SD (standard deviation). Groups were compared by Student's t-test. Groups were also compared by one way analysis of variance (ANOVA) and the significance of mean difference between (inter) the groups was done by Tukey's HSD (honestly significant difference) post hoc test after ascertaining normality by Shapiro–Wilk's test and homogeneity of variance between groups by Levene's test. A two-tailed (α = 2) P < 0.05 was considered statistically significant. Analyses were performed on SPSS software (windows version 17.0). Results: All the cholesterol showed a significant decrease in patients with OSMF than controls, and as the severity of disease increases the decrease in plasma lipid becomes more significant. Thus, this study proves the alteration in plasma lipid in patients with OSMF. Conclusions: This study concluded that the lower serum lipid levels may serve as a diagnostic indicator or marker in the early diagnosis of oral premalignant and malignant lesions.

Keywords: HDL, lipid profile, OSMF, VLDL


How to cite this article:
Anusha, Pratap M, Sinha A, Srivastav S, Mishra A, Iqbal H. Estimation of serum lipid profile in patients with OSMF. J Indian Acad Oral Med Radiol 2018;30:102-6

How to cite this URL:
Anusha, Pratap M, Sinha A, Srivastav S, Mishra A, Iqbal H. Estimation of serum lipid profile in patients with OSMF. J Indian Acad Oral Med Radiol [serial online] 2018 [cited 2018 Aug 18];30:102-6. Available from: http://www.jiaomr.in/text.asp?2018/30/2/102/236724




   Introduction Top


Oral submucous fibrosis (OSMF) is a chronic disease of the oral cavity which is characterized by an epithelial and subepithelial inflammatory reaction followed by fibroelastic changes in the submucosa. It is also an insidious disease that effects the lamina propria of the oral mucosa and, as the disease advances, it involves tissues deeper in the submucosa of the oral cavity with resulting loss of fibroelasticity. This disease manifests with blanching, stiffening of oral mucosa leading to limitation of opening of mouth, burning sensation, shrunken uvula, restricted tongue movement, depapillation of tongue, difficulty in chewing food, and vesicle formation. The presence of fibrous bands in lips, cheeks, and buccal mucosa is present.[1] It is the most prevalent precancerous condition in India. It is caused due to excessive use of areca nut and causes fibrosis due to increased synthesis of collagen, and induces the production of free radicals and reactive oxygen species, which are responsible for high rate of oxidation/peroxidation of polyunsaturated fatty acids, which affects essential constituent of cell membrane and may be involved in tumerogenesis.[2]

Lipids are defined as a very heterogenous group of biomolecules that are generally insoluble in water but which readily dissolve in nonpolar solvents, such as ether and chloroform. Lipids may also be defined as hydrophobic or amphiphilic small molecules; the amphiphilic nature of some lipids allows them to form structures such as vesicles, liposomes, or membranes in an aqueous environment. Lipids can be classified based on their composition and the functions they perform.[3] On the basis of their composition, lipids are broadly classified into simple lipids (esters of fatty acids with alcohol; these include fats, waxes), complex lipids (esters of fatty acids with alcohols containing additional groups such as phosphate, nitrogenous base, carbohydrate, protein etc.; these include phospholipids, nonphosphorylated lipids, lipoproteins, sulfolipids), and derived lipids (derivatives obtained on the hydrolysis of simple and complex lipids which possess the characteristics of lipids; these include eicosanoids, isoprenoids, fat soluble vitamins, steroids, ketone bodies, fatty acids). On the basis of their function, lipids are broadly classified as storage lipids (fats, oils), structural lipids (phospholipids, nonphosphorylated lipids), and lipids as signals, cofactors and pigments (phosphatidylinositol, eicosanoids, steroid hormones, fat soluble vitamins, lipidquinines, dolichols).[3]

Lipids are an important part of living cells. Cholesterol and triglycerides are easily stored in the body. They serve as a source of fuel and are important constituent for the structure of cells. These are major cell membrane components essential for various biological functions, including cell growth and division of normal and malignant tissues.[4] The decrease in the level of cholesterol has been associated with an increased risk of cancer.[5] Cellular uptake and regulation of cholesterol is mediated by lipoprotein receptors, especially located on the surface of the cells. For transport in plasma, triglycerides and cholesterol are packaged into lipoproteins which are then taken up and degraded by cells to fulfil demands for cellular functions. In some malignant diseases, blood cholesterol undergoes early and significant changes. Low level of cholesterol in the proliferating tissues and in blood compartments could be due to carcinogenesis. Usefulness of variations in tissues/blood cholesterol levels in diagnosis and treatment of various disease has been proved.[6]

Despite the high prevalence of premalignant condition like OSMF and their potential to undergo malignant transformation, this condition has not widely been investigated with respect to the serum lipid levels. Early detection is also called as secondary prevention. It is, therefore, important to identify new diagnostic and predictive approaches. Low levels of lipids serves as a marker and prognostic indicator in early detection of oral precancerous and cancerous states. The serum lipid levels have been found to be lower in patients with OSMF than in controls.[7]

Thus, the aim of the study was to estimate the serum lipid profile in patients with OSMF. The objectives were to compare serum lipid profile in patients with OSMF and controls in different age group and also to compare serum lipids in different stages of OSMF.


   Materials and Methods Top


The study was designed among patients reporting to the outpatient Department of Oral Medicine and Radiology in Sardar Patel Institute of Dental and Medical Sciences and Hospital, Lucknow. Study comprised 150 participants, out of those 120 had PSMF, and 30 cases of controls matched for age and sex were selected from the routine patients attending the Department of Oral Medicine and Radiology. Male patients having clinical signs of OSMF and who were within the age group of 20–50 years were considered for the study. These patients were explained the purpose of the study, and those who gave consent were further evaluated. These patients were recalled next day with 12-hour fasting for estimation of serum lipid profile. Venous blood samples were drawn for estimation of serum lipid profile at O.P Chaudhary hospital.


   Results Top


In total. 120 male patients of OSMF were studied. Maximum patients were in the second decade of life. The mean serum lipid profile when compared between two groups, t-test showed significantly (P< 0.05 or P < 0.01 or P < 0.001) different and decrease TC (5.6%), HDL (17.1%), and LDL (4.0%) in OSMF 1 as compared to controls. However, mean VLDL and TG not differ (P > 0.05) between the two groups, but TC (5.8%) and HDL (3.5%) are respectively lowered in OSMF 1 as compared to control.

t-test showed significantly (P< 0.05 or P < 0.001) different and decrease TC (8.1%), HDL (20.8%) and LDL (8.6%), VLDL (16.3%), and TG (9.3%) in OSMF compared to control.

The serum lipid profile of Control and OSMF 1 is compared with controls in [Figure 1]. Both showed decreased mean serum lipid profile in OSMF 1 compared to control.
Figure 1: Mean serum lipid profile of Control and OSMF

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The serum lipid profile of Control and OSMF 2 is summarized in [Table 1]. It showed decreased mean serum lipid profile in OSMF 2 as compared to controls.
Table 1: Serum lipid profile (Mean±SD, n=30) of control and OSMF 2

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Comparing the mean serum lipid profile between two groups, t-test showed significantly (P< 0.05 or P < 0.001) different and decrease TC (8.1%), HDL (20.8%) and LDL (8.6%), VLDL (16.3%), and TG (9.3%) in OSMF 2 as compared to controls [Table 1].

The serum lipid profile of controls and OSMF 3 is summarized in [Figure 2]. It showed decreased mean serum lipid profile in OSMF 3 as compared to controls.
Figure 2: Mean serum lipid profile of Control and OSMF 3

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Comparing the mean serum lipid profile between two groups, t-test showed significantly (P< 0.001) different and decrease TC (18.2%), HDL (30.4%) and LDL (15.6%), VLDL (22.5%), and TG (11.0%) in OSMF 3 as compared to controls [Figure 2].

The serum lipid profile of Control and OSMF 4 is summarized in [Table 2]. It showed decreased mean serum lipid profile in OSMF 4 as compared to controls.
Table 2: Serum lipid profile (Mean±SD, n=30) of control and OSMF 4

Click here to view


Comparing the mean serum lipid profile between two groups, t-test showed significantly (P< 0.001) different and decrease TC (29.2%), HDL (40.4%) and LDL (40.6%), VLDL (27.6%), and TG (15.6%) in OSMF 4 as compared to controls [Table 2].

The serum lipid profile of Control and OSMF patients in 40–50 years age group is summarized in [Figure 3]. In 40–50 years age group, the mean serum lipid profiles were also comparatively lower in OSMF patients compared to controls [Figure 3].
Figure 3: Mean serum lipid profile of Control and OSMF in 41-50 yrs age

Click here to view


In 41–50 years age group, comparing the mean serum lipid profile between the two groups, t-test showed significantly (P< 0.001) different and lower HDL (29.0%), LDL (21.8%), and TG (10.8%) in OSMF patients as compared to controls [Figure 3]. However, mean TC and VLDL not differ (P > 0.05) between the two groups though lower 9.9% and 12.6%, respectively, in OSMF patients as compared to controls.


   Discussion Top


In the present study, 150 cases were included in which 120 were male patients with OSMF and 30 were controls with matched age and sex. The reason behind the selection of only male patients was that there is significant difference in lipid of males vs females. A study was done by Habib et al. showed that women have significantly different lipid profiles than men regardless of menopausal status. In women TG, TC/HDL ratio, and high levels of HDL-C are more than in men. Lipid parameters are different in both genders and this difference is independent of age and menopausal status. Presumably, these differences are due to different levels of circulating sex hormones, specifically estrogens and androgens in women versus men.[8]

The patients with OSMF were divided into groups based on severity of OSMF. They were grouped according to the classification given by Ranganathan et al.[9] This classification is the most widely accepted as it based on clinical feature i.e., groups 1, 2, 3, and 4.

In the present study, OSMF group 1 patient were mostly (37.5%) between the age of 20 and 30 years. While group 4 OSMF patients were observed to be (40%) in age range of 41–50 years. Our observation revealed that the severity of OSMF increases with the age. This could have happened because of chronic use of areca nut, which may have resulted in disease progression.

In the present study, comparison of the serum lipid profiles among OSMF groups and corresponding controls showed that there was a decrease in TC, LDL, VLDL, and TG level in the study group compared to controls. This decrease was not significant in OSMF group 1 while the decrease of TC, LDL, VLDL, and TG was highly significant in group 3 and group 4. These findings were consistent with the studies done by Patel et al.[10] and Lohe et al.[11] who also observed decrease in TC, LDL, VLDL, and TG levels in OSMF patients. There results showed that TC, LDL, VLDL, and TG is not altered much in the initial stages of OSMF but decreases significantly with the chronicity of the disease. While HDL was significantly decreased in all the groups of OSMF. Thus, HDL starts decreasing with disease onset and continues to do so till the advanced stages of the disease. It shows highest decrease in OSMF group 4.

Another comparison was made between OSMF groups and all the parameters of serum lipid. This study shows that the mean lipid levels were reduced in OSMF group 1, group 2, and group 3. In group 4, all serum lipids were reduced significantly compared to the other three groups. An inverse relation was observed between the cholesterol and disease stages. It was reduced highly in group 4 because of the reason that it the most advanced stage and few cases have shown malignant transformation. In 1999, Grieb et al.[12] showed a relatively high risk of cancer with a significant lower total cholesterol and HDL. A similar study by Sharma et al.[13] showed a significant decrease in serum cholesterol, LDL in OSMF patients, which was similar to the present study. In contrast to this study, they also observed increased levels of HDL, which was decreased in our study. Gupta and Gupta [14] observed a significant decrease in plasma TC and HDL in patients with the precancerous lesions and conditions as compared to the controls similar to our study. In the present study, we also observed significant decrease in TG level in OSMF patients.

The result of the present study clearly showed that the serum TC, HDL, LDL, VLDL, and TG were significantly reduced as the disease severity increased among the groups of OSMF, and this reduction was the most significant in group 4 OSMF, where five cases of malignant transformation were also seen.

These observations were supported by the various authors which may occur due to the reason that the lipids are major cell membrane components required for growth and division of normal cells. Cholesterol is an essential constituent of lipoprotein fractions such as LDL, HDL, and VLDL, and 75% of the plasma cholesterol is transported in the form of LDL. In some malignancies, serum cholesterol undergoes early and significant changes. Low levels of cholesterol in the proliferating tissues and in blood compartments could be due to the rapidly dividing cells in malignancies. An inverse trend is observed between lower serum cholesterol and premalignant conditions also. This may be due to greater utilization of lipids including total cholesterol, lipoproteins and triglycerides for new membrane biogenesis as well as accumulation of esterified cholesterol in tumoral tissues.

In the present study, serum lipid profile in OSMF patients was compared with controls after clinical and functional grading. A significant reduction in the levels of TC, TG, HDL, LDL and VLDL was seen as the grade of OSMF advanced and age increases. This was in accordance to studies done by Kanthem and Guttikonda.[15] where similar findings were found.


   Conclusion Top


The present in-vitro study concludes that the lower serum lipid levels may serve as a diagnostic indicator or marker in the early diagnosis of oral premalignant and malignant lesions. Low levels of cholesterol may be due to the rapidly dividing cells in pre-malignancies and malignancies. My observations in this study, suggests that decrease in total cholesterol in patients with OSF which is a potentially malignant disorders and in our study fever cases of OSF even has malignant transformation, and hence, the decrease in lipid profile could be due to the greater utilization of lipids including total cholesterol by the cells for new membrane biogenesis. So due to greater utilization of lipids the serum lipid profile in patients with OSMF were reduced. So, we can conclude that the change in lipid profile levels may have a diagnostic or prognostic role in the early diagnosis of Oral premalignant and malignant lesions. It is an easy and inexpensive method for diagnosis. This requires an in-depth study on larger sample size to confirm its diagnostic and prognostic efficacy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Saman W, Ross K, Alan M, Thomas D, Ajura J. Oral Submucous Fibrosis. Medical Management. World Workshop on Oral Medcine, Version No-16; November, 2010. p. 1-11.  Back to cited text no. 1
    
2.
Sharma G, Das D, Mukherjee J, Purandare B. Lipid profile in oral submucous fibrosis patients in India-A pilot study. Indian J Basic Appl Med Res 2013;2:790-6.  Back to cited text no. 2
    
3.
Bailwad SA, Singh N, Jani DR, Patil P, Singh M, Deep G. Alterations in serum lipid profile patterns in oral cancer: Correlation with histological grading and tobacco abuse. OHDM 2014;13:573-9.  Back to cited text no. 3
    
4.
Mehrotra R, Pandya S, Chaudhary AK, Jaiswal RK, Singh M, Gupta SC, et al. Lipid profile in oral submucous fibrosis. Lipids in Health and Disease 2009;8:29.  Back to cited text no. 4
    
5.
Mehta R, Gurudath S, Dayansoor S, Pai A, Ganapathy KS. Serum lipid profile in patients with oral cancer and oral precancerous conditions. Dent Res J 2014;11:345-50.  Back to cited text no. 5
    
6.
Chalkoo AH, Risam SS, Farooq R. A study on alterations in plasma lipid profile patterns in OSMF patients. JIAOMR 2011;23:36-8.  Back to cited text no. 6
    
7.
Habib SS, Muhammad A, Waqas H. Gender differences in lipids and lipoprotein (A) profiles in healthy individuals and patients with type 2 diabetes mellitus. Pak J Physiol 2005;1:1-2.  Back to cited text no. 7
    
8.
Ranganathan K, Uma Devi, Joshua E, Bhardwaj A, Rooban T, Viswanathan R. Mouth opening, cheek flexibilty and tongue protrusion parameters of 800 normal patients in Chennai, South India – A baseline study to enable assessment of alterations in oral submucous fibrosis. JIDA 2001;72:77-81.  Back to cited text no. 8
    
9.
Patel PS, Shah MH, Raval GN, Rawal RM, Patel MM, Patel JB, et al. Alterations in plasma lipid profile patterns in head and neck cancer and oral precancerous conditions. Indian J Cancer 2004;41:25-31.  Back to cited text no. 9
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10.
Lohe VK, Degwekar SS, Bhowate RR, Kadu RP, Dangore SB. Evaluation of correlation of serum lipid profile in patients with oral cancer and precancer and its association with tobacco abuse. J Oral Pathol Med 2010;39:141-8.  Back to cited text no. 10
    
11.
Grieb P, Ryba MS, Jagielski J, Gackowski W, Packowski P, Chrapusta SJ. Serum cholesterol in cerebral malignancies. J Neurooncol 1999;41:175-80.  Back to cited text no. 11
    
12.
Gupta S, Gupta S. Alterations in serum lipid profile patterns in oral cancer and oral precancerous lesions and conditions - A clinical study. Indian J Dent 2011;2:1-6.  Back to cited text no. 12
    
13.
Sharma G, Das D, Mukherjee J, Purandare.B. Lipid profile in oral submucous fibrosis patients in India – A pilot study. Indian J Basic Appl Med Res 2013;2:790-6.  Back to cited text no. 13
    
14.
Gupta S, Gupta S. Alterations in serum lipid profile patterns in oral cancer and oral precancerous lesions and conditions – A clinical study. Indian J Dent 2011;2:1-6.  Back to cited text no. 14
    
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Kanthem RK, Guttikonda VR. Serum lipid profile in oral submucous fibrosis: A clinic pathological study. J Oral Maxillofac Pathol 2015;19:139-44.  Back to cited text no. 15
[PUBMED]  [Full text]  


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