University of Iowa researchers are working to study the correlation between oral and metabolic health, a category Iowa particularly falls behind in according to Iowa Health and Human Services. Iowa ranks 11th in the nation for adult obesity and one of 19 states with an adult obesity rate at or above 35 percent. 

The researchers were awarded an over $3.5 million grant from the National Institutes of Health to study the correlation between metabolic and oral health. 

Sukirth Ganesan, associate professor in the UI College of Dentistry and the principal investigator of the study, said the total amount of the grant per year depends on the federal budget, but it will exceed $3.5 million for the five-year duration. 

According to the American Council on Education, at the beginning of the year, the U.S. House of Representatives passed a budget that gave the National Institute of Health $48.7 billion and rejected a 40 percent cut from the Trump administration. 

Ganesan said the grant runs for up to five years, during which 240 patients will be tracked as they improve their metabolic health through losing weight, using medications, and improving diet and exercise to see if their oral health follows suit.

Ganesan said the study follows a previous cross-sectional study, or a study analyzing a population from a single point of time, in which 300 patients with metabolic issues such as obesity or diabetes were closely analyzed to determine whether the patients had oral bacterial profiles that resembled those seen in gum disease, even before clinical symptoms appeared.  

The cross-sectional study found that even though the patients’ teeth and gums looked healthy on a dental exam, the bacteria living in their mouths looked similar to what would be seen in people with severe gum disease. 

The new study will follow 240 patients over time, rather than analyzing them at a single point in time. Ganesan said he and his team will examine how improvements in metabolic health affect oral bacteria, metabolites, or tiny chemicals the body produces when processing food and energy. In people with obesity, changes in metabolites can encourage the growth of harmful mouth bacteria and increase inflammation.

Ganesan said while there are many studies approaching the idea of the connection between oral and metabolic health, many of their findings are contaminated by patients who already have had gum disease, other diseases such as type two diabetes, or who partake in habits that negatively impact oral health, such as smoking.

“There are so many confounding factors in the studies because some people start smoking, some people drink alcohol, or they have poor oral hygiene,” he said. “Understanding the mechanism connecting oral health and systemic health is lacking.”

Ganesan said his patients were intentionally picked if they showed healthy mouths and did not have a history of other factors independent of metabolic health that could affect their oral health, such as smoking. 

Ganesan said he hopes his study will make the public aware that oral health is an indicator of overall health. Ganesan noted the mouth is the gateway to the body and the start of the digestive system, making it closely connected to systemic health. 

“The mouth is a great system,” he said. “It’s an ecosystem that’s even more unique because we talk and we eat with it, there’s a constant exposure to the external environment, and there’s a constant exposure to the internal environment within the mouth.”

Ganesan said he wants to see policy changes that encourage people with metabolic issues to visit the dentist more often, pointing to the increased coverage insurance will give for such clients as a step in the right direction. 

“When someone has type 2 diabetes, when they go and see a dentist, insurance will cover them to have extra visits because they are proven to have risk factors,” he said. “Our goal is that with these findings, we can start working towards policy changes like that.” 

Eric Taylor, a professor in the UI’s Carver College of Medicine and the faculty director of the Metabolomics Core Facility, a lab which houses the instruments used to analyze the metabolite samples in the study, said if the team is able to understand how oral health changes with metabolic health and how the patient’s mouths compare to those with gum disease, they can provide more preventative care. 

“It’s like, did the chicken or the egg come first?” Taylor said. “With the differences that we see, we can potentially use them as prognostics to understand disease trajectory.”

Taylor said measuring obesity is complex; it can be measured by the ratio of fat to lean mass, but the individual drivers of the condition, and in turn the solutions, vary from person to person. 

Taylor said he hopes the study’s findings will be a step toward incentivizing the emerging tactic of precision medicine, a health care approach that customizes disease prevention and treatment based on the patient’s lifestyle and genetic makeup. 

“Anything that we can learn to move the needle that will change understanding of obesity, that can inform treatments for obesity, certainly can help within the state of Iowa,” he said. 

Ashutosh Mangalam, a professor of pathology in the UI’s Carver College of Medicine and a collaborator in the study, said he helped to mentor Ganesan before his days as an associate professor. 

Mangalam said the two have had a good relationship since he mentored Ganesan. Managalam said the two have submitted a request for a new grant.

Managalam said the grant focuses on how oral health and bacteria can contribute to or worsen Multiple Sclerosis, an autoimmune disease.

Looking at Ganesan’s current project, Managalam said he is proud and unsurprised that Ganesan received the large grant. 

“It is amazing,” he said. “He’s more like a colleague than being mentored, because he is very hard working, and he has clarity on what he does. So it has been a blessing to be mentor of him, and now he’s tenured and an associate professor.”