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On the one hand, periodontitis can influence the development and state of chronic systemic inflammation, through the aberrant increase in proinflammatory cytokines, such as IL-1, IL-6 and TNF-, affecting endothelial function, and substantially contributing to the development of insulin resistance, causing a homeostatic imbalance in blood glucose regulation ( Figure 1 TNF- plays a crucial role in regulating the expression of endocan, a soluble proteoglycan that is highly produced by vascular endothelium during endothelial activation and inflammatory processes (Sarrazin et al., 2006)

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[2] While protein supplementation supports nutritional adequacy, it cannot compensate for inadequate overall caloric intake

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