From the concept of Inflammaging to P4 Medicine
Human aging is characterized by a chronic low grade on inflammation and this phenomenon has been called “inflammaging” (Franceschi & Campisi, 2014).
Inflammaging is a significant risk factor for mortality in the eldery peolpe.
Aging phenotypes (Claudio Franceschi et al, 2014)
Factors that prevented healthy aging
(Bell, Willcox et al., 2014)
There is evidence that a state of mild and chronic inflammation, revealed by elevated levels of inflammatory biomarkers sush as c-reactive protein and IL-6 is associated and PREDICTIVE of many aging phenotypes as:
Susceptibility to infection
IL-6 is the most important cytokine that is shared across age-related pathologies with chronic inflammatory component.
Moreover, inflammatory biomarkers such as IL-6 and TNF alfa downregulate insulin, insulin-like growth factor 1, erytropietin and protein synthesis after a meal (Franceschi & Campisi, 2014).
Identify biomarkers as IL-6 and TNF alfa could predict ten years ahead all causes of mortality: circulating pro-inflammatory molecules are strong predictors of age related mortality (Dregan, Charlton, Chowienczyk, & Gulliford, 2014).
WHY IS IMPORTANT THE MANAGEMENT OF PATIENTS WITH CHRONIC INFLAMMATORY DISORDER
The study of Dregan et al., 2014 points out that the risk of cardiovascular diseases and type 2 diabetes mellitus is increased across a range of multisystem chronic inflammatory disorders (listed in table 1) with evidence that a risk is associated with severity of inflammation. In the end we can affirm that clinical mangement of patients with chronic inflammatory disorders should reduce cardiovascular risk as we can see in the table below.
TABLE 1: list of chronic inflammatory disorders and number of peolpe with corresponding phatologies
Dregan et al. 2014
Systemic VasculitisBullous skin Disease
Type 2 diabetes
Coronary artery disease
Cronic inflammation may be associated with atheromatous disease, coronary heart disease and stroke, as well as insuline resistance.
Another important article about this phenomenon is the study of Choi et al (Choi et al., 2014) that show that there is a stronger association between periodontal disease and diabetes in people having elevated CRP. This may suggest that chronich inflammatory conditions could increase the impact of periodontitis on hyperglycemic status.
PERIODONTAL HEALTH AND PREVENTION OF SYSTEMIC CHRONIC DISEASES IN THE AGING PATIENT
Propotion od adults >65 years of age will grow to 21,7% of the population by 2040 and 98,2 million >65 years of age will be living in US BY 2060 (Eke et al., 2016).
Oral health is an important component of an older adult’s health infact we know that poor oral health can affect sustemic health.
The prevalence of periodontitis has been shown to be significantly higher in 70 to 81 years old subjects: periodontitis is the sixth most prevalent chronic condition in the world that can lead to a chronic inflammatory status of the body.
In a recent study in Italy severe and moderate periodontitis were 34,94% and 40,78% (Aimetti et al., 2015)
11% of individuals in the general population are affected by the severe type of periodontitis and it’s more common in older adults: this is way we have to change our way to delivery dental care
Noncommunicable diseases as cardiovascular disease, cancer, respiratory disease, type 2 diabetes are now leading cause of death, disability and diminished quality of life in the World. This is why the healthcare professionists must evolve into a proactive system.
Now, as healthcare professionists, we have to focus on the prevention of chronic disease and associated risk factors.
THE NEW APPROACH: P4 MEDICINE
The new approach focusing on care that is:
1) PREDICTIVE: detect disease pre-cursors allows pro-active interventions. Predictive medicine is essential for prevention. Clinically useful biomarkers can be use for patient stratification.
2) PREVENTIVE: prevention of chronic disease of the elderly
3) PERSONALIZED: genetic predisposition play a role in inflammaging. Genetic tests lead to the opportunity for patient stratification and improve prevention of chronic diseases
4) PARTECIPATORY: improve health literacy. From the definition of “health literacy” WHO: “people’s knowledge, motivation and competences to access, understand, appraise and apply health information in order to make judgements and take decisions in every day life concerning health care, disease prevention and health promotion to maintain or improve quality of life during the life course.(Sagner et al., 2017)”
Author: Dott.ssa Sofia Drivas
A.I.R.O Accademia Italiana ricerca Oralewww.ricercaorale.it President: Prof. Luca Viganò
Scientific Coordinator: Dott.ssa Cinzia Casu
Aimetti, M., Perotto, S., Castiglione, A., Mariani, G. M., Ferrarotti, F., & Romano, F. (2015). Prevalence of periodontitis in an adult population from an urban area in North Italy: findings from a cross- sectional population-based epidemiological survey. Journal of Clinical Periodontology, 42(7), 622– 631. https://doi.org/10.1111/jcpe.12420
Choi, Y.-H., McKeown, R. E., Mayer-Davis, E. J., Liese, A. D., Song, K.-B., & Merchant, A. T. (2014). Serum C- reactive protein and immunoglobulin G antibodies to periodontal pathogens may be effect modifiers of periodontitis and hyperglycemia. Journal of Periodontology, 85(9), 1172–1181. https://doi.org/10.1902/jop.2014.130658
Eke, P. I., Wei, L., Borgnakke, W. S., Thornton-Evans, G., Zhang, X., Lu, H., … Genco, R. J. (2016). Periodontitis prevalence in adults ≥ 65 years of age, in the USA. Periodontology 2000, 72(1), 76–95. https://doi.org/10.1111/prd.12145
Franceschi, C., & Campisi, J. (2014). Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 69 Suppl 1, S4-9. https://doi.org/10.1093/gerona/glu057
Sagner, M., McNeil, A., Puska, P., Auffray, C., Price, N. D., Hood, L., … Arena, R. (2017). The P4 Health Spectrum – A Predictive, Preventive, Personalized and Participatory Continuum for Promoting Healthspan. Progress in Cardiovascular Diseases, 59(5), 506–521. https://doi.org/10.1016/j.pcad.2016.08.002