Saliva and Nutrition in Mexican-Americans with Niddm

Dodds, Michael

Abstract

Noninsulin-dependent diabetes mellitus (NIDDM) is a major health problem affecting the Mexican American population, with nearly 25% of the 45-74 year age group afflicted with this disease. Diabetes may affect oral health in a number of ways, but one particular route would be through effects on the production and composition of saliva. A reduction in the quantity of saliva produced could result in dry mouth (xerostomia) causing a number of subjective problems and predisposing the patient to increased dental disease (caries). Diabetes may also affect the protein composition of the saliva. The overall objective of this proposal is to study salivary flow rates and composition in 30 Mexican Americans suffering from NIDDM over a period of six months in order to determine whether improvements in their level of glycemic control result in increased flow rates or alterations in the protein composition. In addition, because of the potential for poor nutritional habits to affect both the diabetes condition and salivary flow, nutritional analysis and advice will be given to the patients, and the effects of this on both their diabetes state and saliva will be evaluated.
Specific aims are: 1) to identify Mexican American patients suffering from poorly-controlled NIDDM and to follow them as they complete a program designed to improve their level of glycemic control; 2) to measure whole stimulated and unstimulated saliva, and acid-stimulated parotid saliva flow rates to determine whether improvements in the glycemic control of these patients result in increases in these flow rates favorable for optimal oral health and comfort; 3) to collect parotid saliva and analyze it for protein concentration and composition in order to determine whether there are specific alterations in groups of protein components with improving glycemic control; and 4) to monitor the nutritional status of these patients and to attempt to relate nutrition status and glycemic control in a longitudinal study. Patients will be selected from those enrolled in a diabetes education program at a community health center; criteria for inclusion in this study will be uncomplicated NIDDM with a fasting blood glucose level > 240 mg/100 ml and glycosylated hemoglobin levels > 9%. Patients will be excluded if they are suffering from certain diabetic complications, such as proliferative retinopathy, nephropathy or hypertension, or if they are taking medications known to affect salivary function. Whole stimulated and unstimulated salivary flow rates will be measured and acid-stimulated parotid saliva collected as the patients on entry into the program and over the five week period of the program. Collections will also be made at three and six months. The parotid saliva will be analyzed for protein concentration and composition by high performance liquid chromatography and gel electrophoresis and the data will be compared to the blood glucose and glycosylated hemoglobin levels. The nutrition data and analysis will focus on whether counselling to improve nutrition intake will improve diabetic control and/or saliva flow.