|Year : 2014 | Volume
| Issue : 4 | Page : 374-378
Lipid profile in oral potentially malignant disorders
Prachi Goel1, Ranjana Garg2, Vijay Raghavan1
1 Department of Oral Medicine and Radiology, Seema Dental College and Hospital, Rishikesh, Uttrakhand, India
2 Department of Oral Medicine and Radiology, Divya Jyoti College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
|Date of Submission||19-Aug-2014|
|Date of Acceptance||30-Mar-2015|
|Date of Web Publication||22-Apr-2015|
D/O Umesh Goel, House No 2, Holi Mohalla, Kankhal, Haridwar, Uttrakhand
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: One of the important components responsible for the maintenance of cell integrity is lipids, which are also required for various biological functions like cell division and growth of normal and malignant tissues. It has been proposed that malignancies are associated with changes in lipid profile. Aims and Objectives: The purpose of this study was to evaluate the alterations in lipid profile in untreated patients of oral submucous fibrosis (OSF), leukoplakia, oral lichen planus (OLP) and control group. Materials and Methods: In this hospital-based study, 20 clinically diagnosed patients of OSF, 20 biopsy-proven cases of leukoplakia, 20 biopsy-proven cases of lichen planus and 20 subjects in the control groups were studied. In the samples collected, serum lipids including the following were analyzed: (i) serum cholesterol, (ii) serum triglyceride, (iii) low-density lipoprotein (LDL), (iv) high-density lipoprotein (HDL), and (v) very low-density lipoprotein (VLDL). Results: Serum lipid profile had inverse relationship with oral precancerous conditions/lesions. Serum triglycerides and VLDL levels showed significant reduction in patients with leukoplakia and lichen planus as compared with controls. No significant correlation of the lipid profile has been found in the OSF patients. Conclusion: The above findings strongly warrant a large sample size keeping in mind the types of lichen planus, leukoplakia staging and OSF staging, and their correlation with tobacco habits is required to make it effective as a prognostic tool in life-threatening conditions.
Keywords: High-density lipoprotein, lichen planus, low-density lipoprotein, oral submucous fibrosis, precancerous conditions, precancerous lesions, serum triglyceride, very low-density lipoprotein
|How to cite this article:|
Goel P, Garg R, Raghavan V. Lipid profile in oral potentially malignant disorders. J Indian Acad Oral Med Radiol 2014;26:374-8
| Introduction|| |
Of all the diseases the most common cause of morbidity and mortality in India is oral cancer (OC) which is usually preceded by clinically apparent premalignant lesions and conditions. Around 4-6% of leukoplakia, 4-13% of oral submucous fibrosis (OSF)  and 0.1-2.2% of oral lichen planus (OLP) cases undergo malignant transformation.  The treatment outcome and prognosis is better in patients with premalignant lesions and conditions if they are detected early. The tumor development and progression depends upon the interplay between proliferation, apoptosis and differentiation of cells.  Blood- or serum-based diagnostic and predictive approaches which are safe, economical and amenable to repeated sampling are the need of the hour in early detection of these premalignant lesions and conditions.
One of the important components responsible for the maintenance of cell integrity is lipids, which are also required for various biological functions like cell division and growth of normal and malignant tissues. Free radicals and reactive oxygen species are formed due to tobacco carcinogens which cause oxidation/peroxidation of polyunsaturated fatty acids. This peroxidation further releases peroxide radicals. This affects the essential constituents of the cell membrane and might be involved in carcinogenesis/tumorigenesis.  The lipid peroxidation causes an increased utilization of lipids such as total cholesterol, lipoproteins and triglycerides. The increased requirement of lipids is accomplished either from circulation, by synthesis through the metabolism or from degradation of major lipoprotein fractions like very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), or high-density lipoprotein (HDL). 
The present study was aimed:
I) To evaluate the alteration in plasma lipid profile which included-
- Total cholesterol,
- VLDL and
- Triglycerides (TGL), in untreated patients of OSF, leukoplakia, OLP and the control group, and
II) To assess whether the relation with serum HDL, LDL, VLDL and TGL could be used to determine the prognosis of patients with oral precancer.
| Materials and Methods|| |
This was a hospital-based study consisting of 80 patients, who were selected from the dental out-patient department (OPD) of the college. The subjects were divided into four groups: 20 patients each of leukoplakia, OLP and OSF formed three groups (case groups). The fourth group consisted of a control group, which contained 20 individuals that were not known to be suffering from any systemic disease. Patients who were clinically diagnosed as having leukoplakia, OLP and OSF were randomly selected and histologically proven. Biopsies from the lesions were obtained for the histopathological diagnosis.
Individuals suffering from diseases that can alter lipid profile like diabetic mellitus, uremia, nephritic syndrome, hypothyroidism, hyperthyroidism, acromegaly and individuals on lipid-lowering drugs.
Case proforma was made to record signs, symptoms and detailed history including habits. Patient consents were obtained prior to their inclusion in the study. Fasting blood samples were collected in plain vials and their lipid profiles were analysed in the Dabral Pathology Laboratory Diagnostic Center, Rishikesh. Lipid profile was estimated for serum cholesterol, TGL, HDL, LDL and VLDL by using VITROS DT slide method and Autospan reagents.
For all the values under consideration, mean values along with standard deviation were calculated. The lipid profile variables between various untreated patients of OSF, leukoplakia and OLP were compared using analysis of variance (ANOVA). Student's t-test was used to compare different forms of lipid profile.
| Results|| |
The minimum aged individual in the entire study group was 20 years and the maximum aged individual was 60 years, so the study age group was divided between 20 and 60 years. Control group had three subjects in the age between 21 and 30 years and 31 and 40 years, nine subjects were in the age between 41 and 50 years, and five were in between 51 and 60 years. Case group had 22 subjects in the age between 21 and 30 years, 16 subjects in between 31 and 40 years, 12 subjects in between 41 and 50 years and 10 subjects in between 51 and 60 years.
Control group consisted of 14 males and six females. Case group consisted of 51 males and nine females. Out of the 60 subjects in the case group, OSF group had 20 males and no females, leukoplakia group had 20 males and no females, and OLP group had 11 males and 9 females.
Correlation of lipid profile in control group as compared with normal values
Standard deviation for the normal values of serum TGL, serum cholesterol, VLDL and HDL were 106.82 ± 27.95, 179.96 ± 29.99, 21.17 ± 7.81, and 43.97 ± 5.56, respectively, and that of the control group patients were 113.75 ± 25.70, 179.4 ± 32.64, 22.6 ± 5.13 and 43.2 ± 8.47, respectively, with a P-value of 0.404, 0.944, 0.476 and 0.664, respectively, which were relatively insignificant. Standard deviation of normal values of LDL was 94.28 ± 27.91 and in the control patients the standard deviation was 110.25 ± 33.12. When compared to each other the P-value was 0.039 which was relatively significant as shown in [Table 1]. [Graph 1 [Additional file 1] ] shows the comparison of normal values with the control group values.
Correlation of lipid profile in study group as compared with normal values
In the study group of leukoplakia (Graph 2 [Additional file 2] and [Graph 3 [Additional file 3] ), 60% of patients showed raised serum TGL with standard deviation of 229.3 ± 156.41 pertaining to which the P-value was highly significant i.e., P < 0.05. Serum cholesterol and HDL were increased in 15% of patients and LDL was increased in only 5% of study population and the P-value for this was not significant. VLDL was raised in 60% of patients of leukoplakia with standard deviation of 45.85 ± 31.23 and P-value for this was highly significant i.e., P < 0.05 as shown in [Table 2] and [Table 3].
|Table 3: Percentage (%) of leukoplakia patients showing a change in the lipid profile|
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In the study group of OSF (Graph 4 [Additional file 4] ] and [Graph 5 [Additional file 5] ), 35% of patients showed raised serum TGL with standard deviation of 177.1 ± 175.87 pertaining to which the P-value was not significant. Serum cholesterol was increased in 5% of patients, HDL was increased in 20% of patients, and VLDL was raised in 35% of patients where the P-value for these were insignificant as shown in [Table 4] and [Table 5].
|Table 5: Percentage (%) of OSF patients showing a change in the lipid profile|
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In the study group of OLP (Graph 6 [Additional file 6] ] and [Graph 7 [Additional file 7] ), 70% of patients showed raised serum TGL with standard deviation of 190.6 ± 76.77 pertaining to which the P-value was highly significant i.e., P < 0.05. HDL was increased in 15% of patients and LDL was increased in only 10% of study population whereas the P-value for this was not significant. VLDL was raised in 35% of patients of OLP with standard deviation of 55 ± 69.79 and P-value for this was highly significant as shown in [Table 6] and [Table 7].
|Table 7: Percentage (%) of OLP patients showing a change in the lipid profile|
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| Discussion|| |
According to estimates, every year there are 9 million new cases of cancer and over 4.5 million deaths due to cancer.  In males one of the most common cancers is oral cancer which is also the sixth most common cancer in the world.  In certain types of malignancies there are reports of early and significant changes in phospholipids and cholesterol. Carcinogenesis leads to low levels of cholesterol in the proliferating tissues and blood. 
It has been reported by Chao et al.,  that the neoplastic cells directly utilize cholesterol for their metabolism resulting in hypolipidemia. Hence, the cholesterol levels should be restored at the earliest in cancer patients to avoid conditions that may speed up morbidity and mortality. However, Choi et al.,  have suggested that the decreased levels of serum antioxidative vitamins is the cause of hypercholesterolemia. There is increased lipid peroxidation due to an increase in the number of free radicals following a decrease in the level of antioxidative vitamins in the serum. Lipoprotein fractions like LDL, HDL and VLDL contain cholesterol out of which LDL transports 75% of the cholesterol. Body cells sequester cholesterol from LDL fractions of the lipoproteins and nearly 80% of the plasma LDL is cleared by LDL receptors. 
In the present study, it has been observed that the cholesterol and LDL levels in leukoplakia patients were within the normal range, whereas TGL and VLDL levels were raised in 60% of the patients, and HDL levels were decreased in 20% of the patients. This is in accordance with previous reports by Fevrot et al.  in 1984 and Haltom et al.  in 1998 who have observed elevated TGL levels in the cancer patients. In the OSF patients, TGL and VLDL levels were increased in 35% of the patients and HDL levels were increased in 20% of the patients. These results are in accordance with the study conducted by Chalkoo et al.  in 2011 and in contrast to the study conducted by Mehrotra et al.  in 2009. In the OLP patients, TGL levels were increased in 70% of the patients and VLDL levels were increased in 35% of the patients. Rest all parameters of the lipid profiles were within the normal range which is in contrast to study conducted by Jornet et al.  in 2012.
In present study, serum lipid profile had an inverse relationship with oral precancerous conditions/lesions. Serum TGL and VLDL levels showed significant reduction in patients with leukoplakia and OLP as compared with the controls. No significant correlation of the lipid profile has been found in the OSF patients. Our results are in accordance with the study conducted by Alexopoulos et al.  in 1987, who has also found non-significant correlation in serum TGL levels with controls in the cancer patients, which indicates that during the later stages of carcinogenesis, hypolipidemia occurs and it is an effect rather than the cause of cancer. Hence, it is suggested that the hypothesis of inverse relationship between precancerous and cancerous conditions and hypolipidemia can better be proved following lipid profile analysis in more number of precancerous and cancerous conditions. Altered lipid profile in terms of raised HDL levels in patients with oral precancerous conditions/lesions may be attributed to tobacco smoking.
An in-depth study on a larger sample size keeping in mind the types of OLP, leukoplakia staging and OSF staging, and their correlation with tobacco habits is required to make it effective as a prognostic tool in life threatening conditions. This study proved that there is an altered lipid profile in oral potentially malignant disorders.
| Conclusion|| |
The lipid status may be a useful indicator for early changes occurring in neoplastic cells and serve as one of the early diagnostic aids in such conditions. It is an easy and inexpensive method for diagnosis. This requires an in-depth study on a larger sample size to make it effective as a prognostic tool in this life-threatening conditions.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]