Salivary inflammatory markers and microbiome in normoglycemic lean and obese children compared with obese children with Type 2 diabetes. Oral microbiome in obese and type 2 diabetic children

Background: There is emerging evidence linking diabetes with periodontal disease. Diabetes is a well-recognized risk factor for periodontal disease. Conversely, pro-inflammatory molecules released by periodontally-diseased tissues may enter the circulation to induce insulin resistance. While this association has been demonstrated in adults, there is little information regarding periodontal status in obese children with and without type 2 diabetes (T2D). We hypothesized that children with T2D have higher rates of gingivitis, elevated salivary inflammatory markers, and an altered salivary microbiome compared to children without T2D. Methods: Three cohorts of ages 10-19 years were studied: lean (normal weight - C), obese (Ob), and obese with T2D (T2D). Each subject completed an oral health survey, received a clinical oral examination, and provided unstimulated saliva for measurement of inflammatory markers and microbiome analysis. Results: The diabetes group was less likely to have had a dental visit within the last six months. Body mass index (BMI) Z-scores and waist circumference/height ratios were similar between Ob and T2D cohorts. The number of carious lesions and fillings were similar for all three groups. The gingival index was greater in the T2D group compared to the Ob and C groups. Differences in salivary microbial diversity were minimal between each group, though a few differences in bacterial composition at the genus level were noted between groups. Lachnospiraceae were found to be positively correlated with salivary IL-1β levels for the T2D cohort. Conclusions: Obese children with T2D show a trend toward poorer oral health compared to normal weight and obese children without T2D. This study characterizes the salivary microbiome of children with and without obesity and T2D. This study supports a modest link between T2D and periodontal inflammation in the pediatric population

背景：现有越来越多的证据表明糖尿病与牙周病存在关联。糖尿病是公认的牙周病危险因素；反之，牙周病变组织释放的促炎分子可进入血液循环，诱导胰岛素抵抗。尽管该关联已在成人群体中得到证实，但针对伴或不伴2型糖尿病（Type 2 Diabetes, T2D）的肥胖儿童的牙周状态相关研究仍较为匮乏。本研究提出假设：与无2型糖尿病的儿童相比，2型糖尿病儿童的牙龈炎患病率更高、唾液炎症标志物水平升高，且唾液微生物组结构发生改变。方法：本研究纳入3个年龄在10~19岁的队列：正常体重对照组（C组）、肥胖组（Ob组）以及伴2型糖尿病的肥胖组（T2D组）。所有受试者均完成口腔健康问卷调研、临床口腔检查，并采集未刺激唾液样本，用于炎症标志物检测及微生物组分析。结果：糖尿病组受试者近6个月内就诊牙科的比例更低。肥胖组与T2D组的体重指数（Body Mass Index, BMI）Z评分及腰围/身高比无显著差异。三组受试者的龋损数量与充填修复体数量均无明显差异。T2D组的牙龈指数（gingival index）显著高于肥胖组与正常体重对照组。各组间唾液微生物多样性差异较小，但在菌属水平上存在部分群落组成差异。在T2D队列中，毛螺菌科（Lachnospiraceae）的相对丰度与唾液中白细胞介素1β（Interleukin-1β, IL-1β）水平呈正相关。结论：与正常体重儿童及无2型糖尿病的肥胖儿童相比，伴2型糖尿病的肥胖儿童呈现出口腔健康状况更差的趋势。本研究明确了伴或不伴肥胖及2型糖尿病的儿童的唾液微生物组特征，证实了儿科人群中2型糖尿病与牙周炎症存在轻度关联。