Saliva Insulin as Biomarker of Risk Factors for Metabolic Dysregulation and Caries

Jodi Stookey105 enrolled

Overview

Saliva insulin shows promise as a non-invasive biomarker of high carbohydrate intake and/or insulin resistance, key risk factors for metabolic dysregulation and caries. Saliva insulin monitoring could potentially inform the planning and evaluation of interventions to prevent child obesity, diabetes and caries, without relying on self-reported measures from children, parents, child care providers or teachers. School-based public health screening programs, which have staff and data collection infrastructure in place to regularly and systematically collect saliva during oral health screening, have opportunity to monitor saliva insulin. This randomized controlled trial explores if saliva insulin is responsive to the kinds of obesity and caries intervention currently in progress in schools, namely drinking water intervention. Public health programs may justify adding saliva collection to protocol already in place if saliva insulin data are found to be actionable, i.e. sensitive to risk and intervention.

This randomized controlled trial explores if saliva insulin is responsive to the kinds of obesity and caries intervention currently in progress in schools, namely drinking water intervention. The specific aims of this randomized controlled trial are to: Determine if the standard serving (500 ml) of drinking water normalizes saliva insulin to a greater extent, within 60 min, than no beverage or a standard serving (200 ml) apple juice in elementary school age children. Determine if, in line with lower saliva insulin, 500 ml drinking water significantly alters macronutrient metabolism, within 60 min, relative to no beverage or 200 ml apple juice. Determine if 500 ml drinking water reduces caries risk factors, improves saliva osmolality, pH, buffering capacity and immune response to a greater extent, within 60 min, than no beverage or 200 ml apple juice.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Eligibility

Sex: ALLMin age: 5 YearsMax age: 10 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: UCSF Pediatric Dental Clinic patients New patient exam or recall exams Caregiver and child speak English, Spanish or Chinese Ages 5-10 years San Francisco residents Non-acutely ill (healthy enough to attend school, no fever and no systemic conditions) Exclusion Criteria: Child and caregiver do not speak English, Spanish or Chinese Not a San Francisco resident Under age 5 years Over age 10 years Child unwilling to accept randomized drink assignment Child unable or unwilling to drink water or apple juice Child unable or unwilling to give saliva Child is presenting to the dental clinic for an operative procedure Acute illness, fever, infection or condition that would prevent the child from attending school No remaining space in study group (weight-specific recruitment is complete).

Outcomes

Primary Outcomes

Lower saliva insulin after drinking water compared to juice; compared to no drink

Lower mean saliva insulin; Greater relative odds of saliva insulin below 5mU/I

Time frame: 1 hour

Secondary Outcomes

Different untargeted metabolomic profile after drinking water compared to juice; and after drinking water compared to no drink

The metabolomic profile will be measured by Untargeted Profiling of Primary Metabolism by mass spectrometry at the University of California Davis West Coast Metabolomics Center. Metabolomic data analyses will be done on data normalized by creatinine, log transformed, and mean centered using metaboanalyst software. The metabolomic profiles will be evaluated using Orthogonal Partial Least Squares Discriminant Analysis 2-D score plots and Principal Components Analysis score plots. Both types of analyses are required because each has limitations. This study hypothesizes that in both types of analysis, the 95% confidence ellipse for the saliva metabolomic profile after drinking water does not overlap the 95% confidence ellipse for the metabolomic profile after apple juice; nor does it overlap the 95% confidence ellipse after no drink.

Time frame: 1 hour

Higher saliva pH (potential of hydrogen) after drinking water than after apple juice or no drink

Mean change in saliva pH from baseline to 1 hour after drinking water is significantly more positive than the mean change in saliva pH after apple juice (anticipating a decrease in saliva pH following the apple juice drink)

Time frame: 1 hour

Higher saliva buffering capacity after drinking water than after apple juice or no drink

Greater relative odds of not having 'low' saliva buffering capacity after drinking water compared to apple juice, with 'low' as defined by the CRT buffer capacity test (Ivoclar, Vivadent, Schaan, Liechtenstein); similarly greater odds of not having 'low' buffering capacity after drinking water vs no drink; Greater odds of an improvement in buffering capacity classification (change from baseline to 1 hour after drink treatment) after drinking water compared to apple juice or no drink

Time frame: 1 hour

Significantly higher saliva secretory immunoglobin a (IgA) after drinking water than after apple juice or no drink

Mean change in saliva IgA concentration from baseline to 1 hour after drinking water

Time frame: 1 hour

Saliva Insulin as Biomarker of Risk Factors for Metabolic Dysregulation and Caries

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes