Difference of mandibular trabecular bone fractal dimension values on panoramic radiographs of vegetarians and nonvegetarians in Medan City
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Background: Vegetarians are known to be more susceptible to experiencing bone mineral density decreases compared to nonvegetarians. The trabecular bone is sensitive to any changes that disrupt the balance of bone metabolism. On panoramic radiographs, bone density can be evaluated by analyzing the fractal dimensions (FD) of the mandibular trabecular bone. Purpose: This analytical cross-sectional study aimed to assess the mandibular trabecular bone FD values on panoramic radiographs of vegetarians and nonvegetarians in Medan City. Methods: This study used a purposive-sampling technique and obtained 30 digital panoramic radiographs of vegetarians and nonvegetarians in Medan City, aged 20 to 40 years, between January and February 2023, at the radiology installation of Dental and Oral Hospital Universitas Sumatera Utara and Laboratory Clinic Pramita Medan. Fractal analysis was performed using ImageJ 1.54c software with the box-counting method. The data distribution was assessed using the Shapiro–Wilk test. The data were analyzed using an independent samples T-test. Results: The results showed that the FD values of the mandibular trabecular bone were significantly different between the two groups (p = 0.000). Conclusion: The mean FD values on the panoramic radiographs were lower in the vegetarian mandibular trabecular bone than in the nonvegetarian mandibular trabecular bone. Considerations need to be made by dentists when performing treatments related to mandibular trabecular bone surgery in vegetarians.
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Wozniak H, Larpin C, de Mestral C, Guessous I, Reny J-L, Stringhini S. Vegetarian, pescatarian and flexitarian diets: sociodemographic determinants and association with cardiovascular risk factors in a Swiss urban population. Br J Nutr. 2020; 124(8): 844–52. doi: https://doi.org/10.1017/S0007114520001762
Hargreaves SM, Nakano EY, Zandonadi RP. Brazilian Vegetarian Population-Influence of Type of Diet, Motivation and Sociodemographic Variables on Quality of Life Measured by Specific Tool (VEGQOL). Nutrients. 2020; 12(5): 1406. doi: https://doi.org/10.3390/nu12051406
Pattar S, Shetty P, Shetty GB. Impact of vegetarian versus non-vegetarian diet on health outcomes in male individuals: A comparative study. Adv Integr Med. 2023; 10(1): 1–7. doi: https://doi.org/10.1016/j.aimed.2023.02.001
Nakamura H, Kawashima T, Yamasaki L, Lwin KS, Eguchi A, Hayabuchi H, Tanoe Y, Tanaka S, Yoneoka D, Ghaznavi C, Uneyama H, Shibuya K, Nomura S. Reducing salt intake with umami: A secondary analysis of data in the UK National Diet and Nutrition Survey. Food Sci Nutr. 2023; 11(2): 872–82. doi: https://doi.org/10.1002/fsn3.3121
Salehin S, Rasmussen P, Mai S, Mushtaq M, Agarwal M, Hasan SM, Salehin S, Raja M, Gilani S, Khalife WI. Plant Based Diet and Its Effect on Cardiovascular Disease. Int J Environ Res Public Health. 2023; 20(4): 3337. doi: https://doi.org/10.3390/ijerph20043337
Voll A, Jost L, Jansen P. Heartfulness in Vegans, Vegetarians, and Omnivores. Int J Environ Res Public Health. 2023; 20(6): 4943. doi: https://doi.org/10.3390/ijerph20064943
Arwanto V, Buschle-Diller G, Mukti YP, Dewi ADR, Mumpuni C, Purwanto MGM, Sukweenadhi J. The state of plant-based food development and its prospects in the Indonesia market. Heliyon. 2022; 8(10): e11062. doi: https://doi.org/10.1016/j.heliyon.2022.e11062
Euromonitor International. Top 10 Global consumer trends 2019. 2019. Available from: https://go.euromonitor.com/white-paper-EC-2019-Top-10-Global-Consumer-Trends.html. Accessed 2023 Mar 29.
Hopwood CJ, Bleidorn W, Schwaba T, Chen S. Health, environmental, and animal rights motives for vegetarian eating. Capraro V, editor. PLoS One. 2020; 15(4): e0230609. doi: https://doi.org/10.1371/journal.pone.0230609
Iguacel I, Miguel-Berges ML, Gómez-Bruton A, Moreno LA, Julián C. Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis. Nutr Rev. 2019; 77(1): 1–18. doi: https://doi.org/10.1093/nutrit/nuy045
Desmond MA, Sobiecki JG, Jaworski M, Płudowski P, Antoniewicz J, Shirley MK, Eaton S, Książyk J, Cortina-Borja M, De Stavola B, Fewtrell M, Wells JCK. Growth, body composition, and cardiovascular and nutritional risk of 5- to 10-y-old children consuming vegetarian, vegan, or omnivore diets. Am J Clin Nutr. 2021; 113(6): 1565–77. doi: https://doi.org/10.1093/ajcn/nqaa445
Menzel J, Abraham K, Stangl GI, Ueland PM, Obeid R, Schulze MB, Herter-Aeberli I, Schwerdtle T, Weikert C. Vegan Diet and Bone Health-Results from the Cross-Sectional RBVD Study. Nutrients. 2021; 13(2): 685. doi: https://doi.org/10.3390/nu13020685
Syagata AS. Kepadatan tulang pada vegetarian vegan dan non vegan. Diponegoro, Semarang; 2011. p. 1–34. web: https://eprints.undip.ac.id/35880/1/412_Anindhita_Syahbi_Syagata_G2C007007.pdf
Chuang T-L, Koo M, Chuang M-H, Lin C-H, Huang C-H, Wang Y-F. Changes in Bone Mineral Density and Trabecular Bone Score over Time between Vegetarian and Non-Vegetarian Middle-Aged and Older Women: A Three-Year Retrospective Medical Record Review. Int J Environ Res Public Health. 2022; 19(4): 2445. doi: https://doi.org/10.3390/ijerph19042445
Kranioti EF, Bonicelli A, García-Donas JG. Bone-mineral density: clinical significance, methods of quantification and forensic applications. Res Reports Forensic Med Sci. 2019; 9: 9–21. doi: https://doi.org/10.2147/rrfms.s164933
Falchetti A, Cavati G, Valenti R, Mingiano C, Cosso R, Gennari L, Chiodini I, Merlotti D. The effects of vegetarian diets on bone health: A literature review. Front Endocrinol (Lausanne). 2022; 13: 899375. doi: https://doi.org/10.3389/fendo.2022.899375
Ciosek Ż, Kot K, Kosik-Bogacka D, Łanocha-Arendarczyk N, Rotter I. The Effects of Calcium, Magnesium, Phosphorus, Fluoride, and Lead on Bone Tissue. Biomolecules. 2021; 11(4): 506. doi: https://doi.org/10.3390/biom11040506
Astuti ER, Arifin AZ, Indraswari R, Putra RH, Ramadhani NF, Pramatika B. Computer-Aided System of the Mandibular Cortical Bone Porosity Assessment on Digital Panoramic Radiographs. Eur J Dent. 2023; 17(2): 464–71. doi: https://doi.org/10.1055/s-0042-1749158
Lita YA, Azhari A, Firman RN, Epsilawati L, Pramanik F. Aspek radiografis dan biologis tulang dalam penilaian kualitas tulang pada osteoporosis. J Radiol Dentomaksilofasial Indones. 2019; 3(2): 47–9. doi: https://doi.org/10.32793/jrdi.v3i2.490
Rachmawati N, Firman RN, Epsilawati L, Damayanti MA. Analysis of the panoramic radiographic density of the mandibular bone in the elderly due to increased cortisol levels. J Radiol Dentomaksilofasial Indones. 2022; 6(2): 55. doi: https://doi.org/10.32793/jrdi.v6i2.885
Kartika D, Batubara FY. Analysis of Pulp Chamber Size on Mandibular Second Molar using Biometric Methods on Panoramic Radiograph in Mongoloid Malayan Race Female Population Malayan Race Female Population. 2020; (Icosteerr 2018): 676–8. doi: https://doi.org/10.5220/0010083706760678
Bingül MB, Oğuz F, Evren A. Analysis of mandibular third molar impaction classification with different skeletal malocclusions. Dent J. 2023; 56(4): 213–9. doi: https://doi.org/10.20473/j.djmkg.v56.i4.p213-219
Astuti ER, Iskandar HB, Nasutianto H, Pramatika B, Saputra D, Putra RH. Radiomorphometric of the jaw for gender prediction: A digital panoramic study. Acta Med Philipp. 2022; 56(3): 113–21. doi: https://doi.org/10.47895/amp.vi0.3175
Xu W, Ni C, Wang Y, Zheng G, Zhang J, Xu Y. Age-related trabecular bone loss is associated with a decline in serum Galectin-1 level. BMC Musculoskelet Disord. 2021; 22(1): 1–13. doi: https://doi.org/10.1186/s12891-021-04272-y
Carmo JZB, Medeiros SF de. Mandibular Inferior Cortex Erosion on Dental Panoramic Radiograph as a Sign of Low Bone Mineral Density in Postmenopausal Women. Rev Bras Ginecol Obstet. 2017; 39(12): 663–9. doi: https://doi.org/10.1055/s-0037-1606622
Hanafiah OA, Hanafiah DS, Syaflida R. The Effect of Topical Application of 3% Binahong. J Int Dent Med Res. 2021; 14(2): 736–41. web: http://www.jidmr.com/journal/wp-content/uploads/2021/07/48-D21_1409_Olivia_Afriyanti_Hanafiah_Indonesia-2.pdf
Oliveira ML, Pedrosa EFNC, Cruz AD, Haiter-Neto F, Paula FJA, Watanabe PCA. Relationship between bone mineral density and trabecular bone pattern in postmenopausal osteoporotic Brazilian women. Clin Oral Investig. 2013; 17(8): 1847–53. doi: https://doi.org/10.1007/s00784-012-0882-2
Manja CD, Harahap KI. the Evaluation of Conventional and Digital Radiograph for Radiopacity Assessment of Restorative Materials. Dentika Dent J. 2018; 21(2): 37–40. doi: https://doi.org/10.32734/dentika.v21i2.476
Pacheco-Pereira C, Silvestre-Barbosa Y, Almeida FT, Geha H, Leite AF, Guerra ENS. Trabecular and cortical mandibular bone investigation in familial adenomatous polyposis patients. Sci Rep. 2021; 11(1): 9143. doi: https://doi.org/10.1038/s41598-021-88513-z
Coşgunarslan A, Aşantoğrol F, Soydan Çabuk D, Canger EM. The effect of selective serotonin reuptake inhibitors on the human mandible. Oral Radiol. 2021; 37(1): 20–8. doi: https://doi.org/10.1007/s11282-019-00419-9
Kato CN, Barra SG, Tavares NP, Amaral TM, Brasileiro CB, Mesquita RA, Abreu LG. Use of fractal analysis in dental images: a systematic review. Dentomaxillofac Radiol. 2020; 49(2): 20180457. doi: https://doi.org/10.1259/dmfr.20180457
Ersan N, Özel B. Fractal dimension analysis of different mandibular regions in familial Mediterranean fever patients: A cross-sectional retrospective study. PLoS One. 2023; 18(6): e0288170. doi: https://doi.org/10.1371/journal.pone.0288170
Rahmad A, Azwar A, Zulfian Z. Analisis Kawasan Terbangun di Kota Pontianak Berdasarkan Dimensi Fraktal. Prism Fis. 2023; 10(3): 360. doi: https://doi.org/10.26418/pf.v10i3.58311
Bankhead P. Analyzing fluorescence microscopy images with ImageJ. ImageJ. 2014; (May): 1–195. web: https://confocal.uconn.edu/wp-content/uploads/sites/1081/2016/02/2014-05_Analyzing_fluorescence_microscopy_images.pdf
Fitriani F, Marlina Y, Roziana R, Rahmadini D. Gambaran Asupan Protein, Zat Besi Dan Kadar Hemoglobin Pada Remaja Putri Vegetarian Vegan Di Indonesia Vegetarian Society (Ivs). J Ris Gizi. 2021; 9(1): 11–5. doi: https://doi.org/10.31983/jrg.v9i1.6502
Sutiari NK, Khomsan A, Riyadi H, Anwar F, Kurniati DPY, Astuti W. Status kesehatan dan asupan mikronutrien vegetarian dan nonvegetarian di Bali. J Gizi Klin Indones. 2021; 17(4): 157. doi: https://doi.org/10.22146/ijcn.64443
Fallon N, Dillon SA. Low Intakes of Iodine and Selenium Amongst Vegan and Vegetarian Women Highlight a Potential Nutritional Vulnerability. Front Nutr. 2020; 7: 72. doi: https://doi.org/10.3389/fnut.2020.00072
Neufingerl N, Eilander A. Nutrient Intake and Status in Adults Consuming Plant-Based Diets Compared to Meat-Eaters: A Systematic Review. Nutrients. 2021; 14(1): 29. doi: https://doi.org/10.3390/nu14010029
Nugroho ISP, Muniroh L. Hubungan konsumsi pangan sumber kalsium dan aktivitas fisik dengan kepadatan tulang lacto ovo vegetarian di Yayasan Buddha Tzu Chi Surabaya. Media Gizi Indones. 2018; 12(1): 64. doi: https://doi.org/10.20473/mgi.v12i1.64-71
Bolarinwa OA. Sample size estimation for health and social science researchers: The principles and considerations for different study designs. Niger Postgrad Med J. 2020; 27(2): 67–75. doi: https://doi.org/10.4103/npmj.npmj_19_20
Kivell TL. A review of trabecular bone functional adaptation: what have we learned from trabecular analyses in extant hominoids and what can we apply to fossils? J Anat. 2016; 228(4): 569–94. doi: https://doi.org/10.1111/joa.12446
Kenkre JS, Bassett J. The bone remodelling cycle. Ann Clin Biochem. 2018; 55(3): 308–27. doi: https://doi.org/10.1177/0004563218759371
Zhu X, Zheng H. Factors influencing peak bone mass gain. Front Med. 2021; 15(1): 53–69. doi: https://doi.org/10.1007/s11684-020-0748-y
Osterhoff G, Morgan EF, Shefelbine SJ, Karim L, McNamara LM, Augat P. Bone mechanical properties and changes with osteoporosis. Injury. 2016; 47 Suppl 2(Suppl 2): S11-20. doi: https://doi.org/10.1016/S0020-1383(16)47003-8
McVeigh JA, Howie EK, Zhu K, Walsh JP, Straker L. Organized Sport Participation From Childhood to Adolescence Is Associated With Bone Mass in Young Adults From the Raine Study. J Bone Miner Res. 2019; 34(1): 67–74. doi: https://doi.org/10.1002/jbmr.3583
Molino G, Montalbano G, Pontremoli C, Fiorilli S, Vitale-Brovarone C. Imaging Techniques for the Assessment of the Bone Osteoporosis-Induced Variations with Particular Focus on Micro-CT Potential. Appl Sci. 2020; 10(24): 8939. doi: https://doi.org/10.3390/app10248939
Barnsley J, Buckland G, Chan PE, Ong A, Ramos AS, Baxter M, Laskou F, Dennison EM, Cooper C, Patel HP. Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging Clin Exp Res. 2021; 33(4): 759–73. doi: https://doi.org/10.1007/s40520-021-01817-y
Cavalcante D de S, Silva PG de B, Carvalho FSR, Quidute ARP, Kurita LM, Cid AMPL, Ribeiro TR, Gurgel ML, Kurita BM, Costa FWG. Is jaw fractal dimension a reliable biomarker for osteoporosis screening? A systematic review and meta-analysis of diagnostic test accuracy studies. Dentomaxillofac Radiol. 2022; 51(4): 20210365. doi: https://doi.org/10.1259/dmfr.20210365
Hayek E, Aoun G, Geha H, Nasseh I. Image-based Bone Density Classification Using Fractal Dimensions and Histological Analysis of Implant Recipient Site. Acta Inform Med. 2020; 28(4): 272–7. doi: https://doi.org/10.5455/aim.2020.28.272-277
Carvalho BF, de Castro JGK, de Melo NS, de Souza Figueiredo PT, Moreira-Mesquita CR, de Paula AP, Sindeaux R, Leite AF. Fractal dimension analysis on CBCT scans for detecting low bone mineral density in postmenopausal women. Imaging Sci Dent. 2022; 52(1): 53–60. doi: https://doi.org/10.5624/isd.20210172
Sindeaux R, Figueiredo PT de S, de Melo NS, Guimarães ATB, Lazarte L, Pereira FB, de Paula AP, Leite AF. Fractal dimension and mandibular cortical width in normal and osteoporotic men and women. Maturitas. 2014; 77(2): 142–8. doi: https://doi.org/10.1016/j.maturitas.2013.10.011
Klein L, Dawczynski C, Schwarz M, Maares M, Kipp K, Haase H, Kipp AP. Selenium, Zinc, and Copper Status of Vegetarians and Vegans in Comparison to Omnivores in the Nutritional Evaluation (NuEva) Study. Nutrients. 2023; 15(16): 1–20. doi: https://doi.org/10.3390/nu15163538
Walther B, Guggisberg D, Badertscher R, Egger L, Portmann R, Dubois S, Haldimann M, Kopf-Bolanz K, Rhyn P, Zoller O, Veraguth R, Rezzi S. Comparison of nutritional composition between plant-based drinks and cow’s milk. Front Nutr. 2022; 9: 988707. doi: https://doi.org/10.3389/fnut.2022.988707
Singh J, Arora SK. Antinutritional factors in plant based foods. Int J Agric Sci. 2023; 19(1): 366–75. doi: https://doi.org/10.15740/HAS/IJAS/19.1/366-375
Thakur A, Sharma V, Thakur A, Vishal Sharma C. An overview of anti-nutritional factors in food. Int J Chem Stud. 2019; 7(1): 2472–9.
Liu Z-M, Huang Q, Long H-H, Li S-Y, Wu Y, Zhang S-J, Tang X-Y, Chen Y-M. Increased Dietary Intakes of Total Protein, Animal Protein and White Meat Protein Were Associated with Reduced Bone Loss-A Prospective Analysis Based on Guangzhou Health and Nutrition Cohort, South China. Nutrients. 2023; 15(6): 1432. doi: https://doi.org/10.3390/nu15061432
Akalu Y, Yeshaw Y, Tesema GA, Demissie GD, Molla MD, Muche A, Diress M, Tiruneh SA. Iron-rich food consumption and associated factors among children aged 6-23 months in sub-Saharan Africa: A multilevel analysis of Demographic and Health Surveys. PLoS One. 2021; 16(6): e0253221. doi: https://doi.org/10.1371/journal.pone.0253221
Putrino A, Marinelli E, Agrillo A, Zaami S. New Perspectives in Third Molar Auto-Transplantation: Literature Review and a Case Report of Clinical, Financial and Forensic Implications. Medicina (Kaunas). 2024; 60(3): 473. doi: https://doi.org/10.3390/medicina60030473
Nguyen TTH, Eo MY, Kuk TS, Myoung H, Kim SM. Rehabilitation of atrophic jaw using iliac onlay bone graft combined with dental implants. Int J Implant Dent. 2019; 5(1): 11. doi: https://doi.org/10.1186/s40729-019-0163-9
Huang X, Zhu W, Zhang X, Fu Y. Modified gingivoplasty for hereditary gingival fibromatosis: two case reports. BMC Oral Health. 2022; 22(1): 1–9. doi: https://doi.org/10.1186/s12903-022-02411-y
Agnoli C, Baroni L, Bertini I, Ciappellano S, Fabbri A, Papa M, Pellegrini N, Sbarbati R, Scarino ML, Siani V, Sieri S. Position paper on vegetarian diets from the working group of the Italian Society of Human Nutrition. Nutr Metab Cardiovasc Dis. 2017; 27(12): 1037–52. doi: https://doi.org/10.1016/j.numecd.2017.10.020
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