Lipids in Health and Disease

Background: Changes in lipid profile have long been associated with malignancies as lipids play a key role in maintenance of cell integrity. This study evaluated the alterations in extended lipid profile in untreated patients of oral submucous fibrosis (OSMF) and studied the correlation between lipid levels with tobacco consumption. Materials and methods: In this hospital-based study, 65 clinically diagnosed and histopathologically proven patients of OSMF and 42 age and sex matched controls were studied. In these samples serum lipids including: (i) Total cholesterol, (ii) LDL cholesterol (LDLC), (iii) HDL cholesterol (HDLC) (iv) VLDL cholesterol (VLDLC) (v) triglycerides (vi) Apo-A1 (viii) Apo-B and (viii) LPa were analyzed. Results: A significant decrease in plasma total cholesterol, HDLC and Apo-A1 was observed in patients with OSMF as compared to the controls. Thus an inverse relationship between plasma lipid levels and patients was found in OSMF. Conclusion: The lower levels of plasma cholesterol and other lipid constituents in patients might be due to their increased utilization. The findings strongly warrant an in-depth study of alterations in plasma lipid profile in patients with oral precancerous conditions. Background 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 [1]. This disease occurs most commonly in South East Asia but cases have been reported worldwide in countries like Kenya, China, UK, Saudi Arabia and other parts of the world [2]. In India, the authors earlier reported that oral submucous fibrosis constituted the highest number of patients in premalignant group in a tertiary level hospital based study at Allahabad [3]. Tilakaratne et al. reported that areca nut is the main etiological factor for OSMF [4]. Pandya et al., again from Allahabad, confirmed that dohra/paan masala containing areca nut is a major risk factor of OSMF, especially in the younger age group. They also reported an increase in hisPublished: 24 July 2009 Lipids in Health and Disease 2009, 8:29 doi:10.1186/1476-511X-8-29 Received: 19 June 2009 Accepted: 24 July 2009 This article is available from: http://www.lipidworld. com/content/8/1/29 © 2009 Mehrotra et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Page 1 of 7 (page number not for citation purposes) Lipids in Health and Disease 2009, 8:29 http://www.lipidworld. com/content/8/1/29 topathological grading with severity and duration of addiction habit [5]. Excessive use of areca nut may cause fibrosis due to increased synthesis of collagen and induce the production of free radicals and reactive oxygen species, which are responsible for high rate of oxidation/peroxidation of polyunsaturated fatty acids which affect essential constituents of cell membrane and might be involved in tumorigenesis [6,7]. Lipids are major cell membrane components essential for various biological functions including cell growth and division of normal and malignant tissues. They are homogeneous group of compounds related more by physical than chemical properties. An alteration in the circulatory cholesterol levels has been found to be associated in the etiology of breast cancer and colorectal cancer [8]. However, only a few reports are available on plasma lipid profile in head and neck lesions [9,10]. A careful search of the literature does not reveal any research in extended lipid profiles in OSMF, and to the best of our knowledge this is the first report of its kind. Materials and methods A hospital based study was conducted in 65 clinically diagnosed and histopathologically proven patients of OSMF attending the outpatient department in the division of Otolaryngology of the Swaroop Rani Nehru Hospital, a tertiary level referral hospital affiliated to the Moti Lal Nehru Medical College, Allahabad, India after the institutional ethical committee clearance. All the patients underwent recording of signs, symptoms, detailed history including habits, histopathology and extended lipid profile estimation. 42 healthy individuals, matched for age and sex, who had no complaint or any other major illness in recent past, were included as controls. Fasting blood samples were collected in plain vials. Serum was collected after centrifugation and stored at -80°C until analyzed. Plasma levels of cholesterol, triglycerides, VLDL, HDL and LDL were calculated by using Autospan Reagents (Span Diagnostics, India). Simultaneously, ApoA1, Apo-B and LPa were estimated by Electrophoresis by the standard technique. Statistical analysis, including calculation of coefficient of variation and Standard deviation was performed utilizing SPSS package. (Tokyo, Japan) Results Sixty five cases of OSMF were studied. Maximum patients (30; 46.2%) were in their second decade (21–30 yrs) of life with a male predominance. According to the addiction habits, 26 (40%) consumed paan masala or dohra (a locally available combination of slaked lime and areca nut), 30.8% patients were addicted to betel quid with tobacco while 16 (24.6%) were smokers. Only 3 (6.6%) did not have any habit. 12 (18.5%) patients had a burning sensation in mouth, 16 (24.6%) had ulceration in the oral cavity, 15 (23%) had excessive salivation while 22 (33.7%) had difficulty in opening the mouth (trismus) (Figure 1). On clinical grading of trismus, 5 patients were found to have grade I (>3 cm), 34 had grade II (2–3 cm), and 26 had grade III (<2 cm) (Table 1). 28 patients consumed paan masala and betel quid with tobacco for 11– 15 years (1–10 times/day), while 17 patients were addicted for 6–10 years (11–20 times/day) (Table 2). There was a significant increase in serum total cholesterol, LDL, VLDL and triglycerides levels (Figure 2, 3, 4). On the other hand, there was significant decrease in HDL and Apo-A1 (Figure 5, 6). No change was observed in Apo-B or Lipoprotein-A (Figure 7, 8) in the patient category compared to the controls (Table 3). Discussion Oral submucous fibrosis has always been a challenging disease with high prevalence in India. In this study, most of the OSMF cases were in the second and third decades of life with a male preponderance and addiction to areca nut. This is in accordance with previous reports from the authors as well other groups. As this is a disease of multifactorial etiology, various workers have proposed different theories of causation to establish the exact nature of the disease [11]. Pan Masala/Dohra were the most significant risk factor in this study but no correlation was found with the lipid profile Lipid Research Clinics Coronary Primary Prevention Trial was a multicentere, double blinded, placebo-controlled trial of the bile acid sequestrant, cholestyramine, among type Ha hypercholesterolemic men, i.e., men with elevated total serum cholesterol due to low-density lipoprotein cholesterol. The trial tested the Showing clinical picture (blanching and fibrosis) in oral submucous fibrosis Figure 1 Showing clinical picture (blanching and fibrosis) in oral submucous fibrosis. Page 2 of 7 (page number not for citation purposes) Lipids in Health and Disease 2009, 8:29 http://www.lipidworld. com/content/8/1/29 Page 3 of 7 (page number not for citation purposes) Table 1: Clinico-pathological attributes in patients of OSMF