Background and Aim: Oral health knowledge is a vital requirement for health-related practice. Adequate knowledge of oral health is important due to its influence to better oral health and in developing healthy oral health practices. This study aims to assess the knowledge, practices towards oral health, and its association with sociodemographic factors amongst government employes and their clients in Kuwait, as well as to provide information that could form the basis for targeted oral health promotion programs. This research also aimed at determining the pattern of oral hygiene practices of the adult employes. Materials and Methods: In this cross-sectional study, data were collected at the Ministries Complex and Housing Authority by a team of trained dentists using a customized questionnaire that was translated into Arabic language. The questionnaire included questions on demographic characteristics; questions about oral health practices; nutrition; knowledge of dental and oral health; and risk factors such as smoking and water pipe use. Results: Respondents in Kuwait demonstrate good oral health knowledge; however, daily dental flossing is inadequately practiced. Nutritional practices such as fast-food consumption and sugary sweet consumption are common amongst the employed adults. Males and smokers have poorer knowledge and inadequate oral hygiene practices. In multivariate analysis, employes having a post school education were significantly associated with an above median knowledge (AOR: 2.34). Male participants (AOR: 0.41) and smokers (AOR: 0.59) were significantly less likely to brush their teeth. Participants who used a water pipe (AOR: 0.57) were significantly less likely to floss their teeth. Conclusions: Majority of participants had a good knowledge level towards oral health. This study highlights the need for educational interventions focusing on comprehensive oral hygiene practices among adults. Further efforts are essential to increase awareness in workplaces to help encourage adult employes in Kuwait in developing healthy oral health practices.

BackgroundOral health issues have received significant attention from most global health agencies, which have integrated these issues into their noncommunicable disease, sustainable development, and universal health coverage objectives.MethodsThis paper provides an update on the progress made in the last 2 decades and aims to highlight some of the challenges faced by the oral health care system in Kuwait.ResultsDespite the nation's rising expenditure on oral health care, the prevalence of oral diseases remains high in Kuwait. The lack of reliable data on periodontitis and edentulism limits the ability of researchers to comment on the trends of these conditions. This emphasises the critical need for a nationwide household-level oral health survey in both pediatric and adult populations that would provide valuable information on the oral health status of these populations.ConclusionIn the future, Kuwait must invest more in oral disease prevention programs, especially among children and the high-risk communities of the population.

Background Understanding oral health behaviour s and their impact on Oral Health-Related Quality of Life (OHRQoL) may serve as an instrument to articulate the conventional oral health policy framework, thereby ameliorating the overall health of young individuals in the long term. Objective The aim of this study was to investigate the relationship between children’s oral health behaviour s and Oral Health-Related Quality of Life in the capital governorate, Kuwait. Methods A cross-sectional study involving 607 children aged 12–14 years, randomly selected from schools in Kuwait Capital Region. A validated Oral Health Behaviour s and OHRQoL Child Perception Questionnaires (CPQ 12-14 ) was used to collect the data. Chi-square, t-tests, and ANOVA were used to examine the association between oral behaviour s and children’s OHRQoL. Results About 52.2% of participants were males and the overall response rate was 93.8%. The mean ± SD for total OHRQoL impact was 3.1 ± 0.58, while the total mean for individual domains- for oral symptoms, functional limitations, emotional well-being and social well-being were 2.89 ± 0.63, 2.89 ± 0.72, 3.1 ± 0.91 and 3.4 ± 0.61, respectively. There was no significant difference in total OHRQoL impact score by frequency of last dental visit, flossing, use of mouth rinse or chewing gum ( p > 0.05) but for the overall OHRQoL, frequency of soft drink intake was the only significant predictor associated with 0.2-unit decrease (B = -0.207, 95% CI, p = 0.002) in total OHRQoL scores. Conclusions High frequency of soft drink consumption was related to poorer OHRQoL. Behaviour changing interventions based on OHRQoL inferences coupled with clinical intervention are needed.

PURPOSE To determine the self-perceived oral health and general health as well as the oral health-related quality of life (OHRQoL) among parents in Kuwait. MATERIALS AND METHODS This cross-sectional study was conducted among parents visiting the School Oral Health Programme (SOHP) clinics in all the governorates in Kuwait. Being a parent and able to read and understand the Arabic language was the inclusion criterion. A convenience sample of parents (n = 2357) were enrolled in this study, which was conducted using a self-administered questionnaire in Arabic. The questionnaire included previously validated questions and also questions designed for this study. The parents completed and returned the questionnaire while waiting for their children in the waiting area of the SOHP clinic. RESULTS The mean age of the parents was 38.3 ± 7.3 years. The majority (75.2%) of the participants perceived their oral health 'excellent', 'very good' or 'good' and 76.4% also rated their general health as 'excellent', 'very good' or 'good'. Overall, higher levels of perceived oral health were reported more frequently by younger participants, females, Kuwaitis, and those who had higher levels of education (p < 0.001). Most of the participants (72.3%) were satisfied with their oral health, (91.0%) enjoyed eating their food and (79.0%) liked their smile. Perceived difficulty in chewing food was stated by only 21.0%, and very few (5.0%) had speech difficulties. Almost half (45.0%) mentioned that they had never had any dental and/or gum problems that affected their daily activities during the past 6 months, nor did such problems influence their social activities. Nearly two-thirds (61.0%) stated that they never had any difficulty in conversation, and half (49.0%) did not report any disturbance in their sleep. Cronbach's alpha (0.89) showed a high degree of internal consistency between different OHRQoL responses. CONCLUSION Most of the parents were satisfied with their oral health, which had an impact on their quality of life.

Background: Oral cancer awareness among newly graduated dentists could have a substantial impact in the prevention and early detection of oral cancer. Objective: This survey was undertaken to assess the knowledge, opinion, attitudes, and practices on oral cancer among newly graduated dentists in Kuwait. Methods: In this cross-sectional study, self-reported questionnaire was distributed to the newly graduated dentists. Of the 310 dentists who participated, 171 (55.2%) were males and 139 (44.8%) were females. The questionnaire included 23- questions on oral cancer knowledge, opinion, attitudes, and practices. Results: The mean age of the dentists was 25.8 ± 2.4 years and their mean years of experience 1.5 ± 1.7 years. Overall, a great majority of dentists (95.8%) recognized tobacco use and alcohol consumption as very important risk factors for oral cancer occurrence. Almost all of participants were aware of the most common form of oral cancer (94.2%). Most of the dentists correctly identified the most common site of oral cancer (93.5%). Majority of the participants recognized the most commonly associated lesions with oral cancer (91.6%). While 37.4% of the dentists agreed that they were adequately trained in oral cancer screening, most (89.7%) believed that patients should have mandatory oral cancer screening at the clinics. Also, majority (95.8%) expressed their willingness to attend continuing education and training courses in cancer screening and prevention. Most of the dentists (81.9%) referred a patient with a suspicious lesion to a specialist. Conclusions: Majority of the dentists were aware and knowledgeable about various aspects of oral cancer. There is a need to emphasize and reinforce the training programs in oral cancer education mainly in prevention and early detection. Continuing education programs and workshops are highly recommended to raise awareness of the dentists on risk factors and diagnosis of oral cancer.

Background: The coronavirus disease 2019 (COVID-19) pandemic has rapidly spread to most countries around the world. Disproportionate spread of COVID-19 among the Indian community in Kuwait prompted heightened surveillance in this community. Aims: To study the epidemiological characteristics of COVID-19 patients and their contacts among the Indian community in Kuwait. Methods: Data collection was done as a part of contact tracing efforts undertaken by the Kuwaiti Ministry of Health. Results: We analysed contact-tracing data for the initial 1348 laboratory-confirmed Indian patients and 6357 contacts (5681 close and 676 casual). The mean (standard deviation) age of the patients was 39.43 (10.5) years and 76.5% of the cases were asymptomatic or had only mild symptoms. Asymptomatic patients were significantly older [40.05 (10.42) years] than patients with severe symptoms [37.54 (10.54) years] (P = 0.024). About 70% of the patients were living in shared accommodation. Most of the close contacts were living in the same household, as compared with casual contacts, who were primarily workplace contacts (P < 0.001). Among the different occupations, healthcare workers had the highest proportion of cases (18.4%). Among the 216 pairs of cases with a clear relationship between the index and secondary cases, the mean serial interval was estimated to be 3.89 (3.69) days, with a median of 3 and interquartile range of 1-5 days. Conclusion: An early increase in the number of COVID-19 cases among the Indian community could be primarily attributed to crowded living conditions and the high proportion of healthcare workers in this community.

PURPOSE To determine the oral health status among adult employees in Kuwait. MATERIALS AND METHODS This cross-sectional study was performed on a convenience sample (n = 1294) of adult employees. Their ages ranged from 19 to 77 years (mean 36.2). Six trained and calibrated dentists examined them using a mouth mirror and a WHO ball-tip probe. Caries was scored using WHO diagnostic criteria. The debris index simplified (DI-S) score was used to assess oral hygiene status. RESULTS Overall, the mean DMFT in the adults was 10.3. The DMFT increased from 7.8 for the age group 19-24 years to 10.7 at 35-44 years and 18.9 at 65-77 years (p < 0.001). Females had slightly higher caries experience (DMFT) (11.0) than did males (10.1) (p = 0.021), and Kuwaitis (11.1) more than non-Kuwaitis (8.9) (p < 0.001). The proportion of caries-free adults was 28%. In multivariate analysis, adults with poor oral hygiene (OR=1.5; 95% CI=1.2-2.1), those with an intermediate-school (grades 6 to 9) or lower level of education (OR=2.6; 95% CI=1.4-4.7), Kuwaitis (OR=1.3; 95% CI=1.0-1.7), those with oral pain (OR=1.4; 95% CI=1.0-1.8), and those needing urgent dental care (OR=4.6; 95% CI=2.6-8.0) were statistically significantly associated with caries risk. About 19.6% of these adults had good, 36.1% fair and 44.4% had poor oral hygiene. Nearly one-third (32.9%) of adults had perceived oral pain at the time of examination. CONCLUSION Implementing oral health programs is needed and efforts should be made to promote oral hygiene practices in workplaces among adults in Kuwait.

Background : The promotion of healthy oral practices during early stages of growth can have a positive impact on the psychology, personality and thus holistic health of individual for entire life. Assessment of determinants of oral health habits and their impact on Oral Health-Related Quality of Life (OHRQoL) may serve as an important instrument to articulate the conventional oral health policy framework, thereby ameliorating the overall health of young individuals in the long term. Objective : The aim of this study was to investigate the relationship between children’s oral health habits and Oral Health-Related Quality of Life among a random students’ sample in the capital governorate, Kuwait. Methods : A cross-sectional study was conducted with 607 students, aged 12-14 years, selected randomly from the Capital in Kuwait. Collection of behavioural data was done using the validated English and Arabic Oral Health and OHRQoL CPQ12-14 following prior informed consent of parents/guardians of students enrolled in the study by trained interviewers. Statistical analysis was performed with SPSS 22.0 and using Shapiro- Wilks test for the determination of continuous variables for normal distribution along with frequency and percentage distribution determined the categorical variables in the form of oral health behaviours interpreted as non-fractional numerical scores. Chi-square, t-tests and ANOVA were used to evaluate the variation pattern in oral health among the subjects to determine the association of oral behaviours with child OHRQoL. Results : About 52.2% subjects were males and the overall response rate was 93.8%. The mean for total OHRQoL impact was 3.1 while the total mean for individual domains- for oral symptoms, functional limitations, emotional well-being and social well-being were 2.89, 2.89, 3.1 & 3.4, respectively. There was no significant difference in total OHRQoL impact score by frequency of last dental visit, flossing, use of mouth rinse or chewing gum but for the overall OHRQoL, frequency of soft drink intake was the only significant predictor associated with 0.2-unit decrease in total OHRQoL scores. Conclusions : Though excess soft drink consumption was related to poorer OHRQoL and an unhealthier lifestyle yet research towards behaviour changing interventions based on OHRQoL inferences coupled with clinical intervention are warranted.

Background: Oral cancer signifies a public health concern of international importance. Early detection of oral cancercan improve the prognosis and the 5-year survival rate. Objective: The aim of this study was to assess the level of oralcancer knowledge, opinion, attitudes and practices among dentists working at the primary oral health care centers inKuwait. Methods: In this cross-sectional study, self-reported questionnaire was distributed to the dentists working atthe primary oral health care centers in Kuwait. A total of 289 dentists participated in the present study. The questionnaireincluded 23- questions on oral cancer knowledge, opinion, attitudes and practices. Results: The mean age of the dentistswas 35.2 ± 10.9 years. Approximately, all dentists (99.7%) were aware of the major risk factors that were most likelyassociated with oral cancer. Overall, majority of the participants knew the most common form of oral cancer (80.6%),most common site (80.3%) and the likely lesions associated with oral cancer occurrence (87.9%). A large number ofdental practitioners (81%) would routinely refer a patient with a suspicious lesion to a specialist. Nearly one-third (32%)reviewed their patients’ oral cancer risk factors. Approximately two-thirds (62%) assessed the use of tobacco in theirpractice. Almost, all (92.4%) were interested in attending continuing education courses on oral cancer. Conclusions:Majority of the participants presented good knowledge about various aspects of oral cancer. More continuing educationprograms on risk factors and diagnosis of oral cancer should be organized to train the dentists. Oral cancer screeningshould be a routine procedure for the high risk patients at the primary oral health care centers in Kuwait.

In a longitudinal study of 6,158 Kuwaiti children, we selected 94 for salivary metabolomic analysis who were neither obese (by waist circumference) nor metabolic syndrome (MetS) positive (<3 diagnostic features). Half (43) remained healthy for 2 years. The other half (51) were selected because they became obese and MetS positive 2 years later. In the half becoming obese, metabolomic analysis revealed that the level of salivary N1-Methyl-2-pyridone-5-carboxamide (2PY) had the highest positive association with obesity (p = 0.0003, AUC = 0.72) of 441 salivary biochemicals detected. 2PY is a recognized uremic toxin. Also, 2PY has been identified as a biomarker for uranium uptake. Considering that a relatively recent military conflict with documented uranium contamination of the area suggests that this weight gain could be a toxicological effect of long-time, low-level uranium ingestion. Comparison of salivary 2PY in samples from the USA and Kuwait found that only Kuwait samples were significantly related to obesity. Also, the geographic distribution of both reported soil radioactivity from 238U and measured salivary 2PY was highest in the area where military activity was highest. The prevalence pattern of adult diabetes in Kuwait suggests that a transient diabetogenic factor has been introduced into the Kuwaiti population. Although we did not measure uranium in our study, the presence of a salivary biomarker for uranium consumption suggests potential toxicity related to obesity in children.

Chemical compounds in the saliva most likely to be associated with obesity are identified in a metabolomic analysis of paired whole saliva and plasma samples from 68 children (10-year old) who have also been evaluated for their gingival redness.Results Through metabolomic analysis119 compounds were found only in saliva, 210 only in plasma and 126 in both. The most common plasma metabolites were lipids. The most common saliva metabolites were peptides. Amino acids and their metabolites were common in both samples.Surrogate indicators were identified by computing correlations between saliva and plasma. 29 of the 126 found in both saliva and plasma had significant positive correlation and only 4 of those (urate, creatinine, pipecolate and hydroxyproline) were associated with obesity as potential surrogate biomarkers. The uremic toxin N1-Methyl-2-pyridone-5-carboxamide (2PY) was also elevated in the saliva of obese children. 21 biochemicals were elevated in both obesity and gingivitis suggesting that some biochemical pathways for gingivitis and obesity are shared.Of the metabolites found only in saliva, 35 were associated with obesity (p<0.01). The most significant was phosphate. Saliva had 53 dipeptides, seven of which were associated with obesity. Two volatile amines (putrescine and cadaverine) and their amino acid precursors (ornithine and lysine) were also associated with obesity.Of the metabolites found only in plasma, 64 were associated with obesity (p<0.01). Significant increases in branched-chain and aromatic amino acids, significant reductions in serotonin, serine, and glycine and increased androgen metabolism are changes observed in 10-year old obese children that have also been reported with adult patients having type II diabetes.Conclusions Salivary urate may be a valuable measure of metabolic disease particularly in association with fructose consumption. Elevated salivary creatinine levels and presence of 2PY suggests a possible association of obesity with developing kidney disease in obese children. Though not a surrogate variable, salivary phosphate, (AUROC= 0.8) could also be an important indicator of obesity. Cadaverine, putrescine and dipeptides are also likely oral bacterial products that could help define the metabolic pathways responsible for obesity. The results of this study indicate that salivary metabolites can be important indicators of developing metabolic disease in children and provide a biochemical signature in the pathways that lead to obesity.

BACKGROUND:Type II diabetes (T2D) has been associated with changes in oral bacterial diversity and frequency. It is not known whether these changes are part of the etiology of T2D, or one of its effects. METHODS:We measured the glucose concentration, bacterial counts, and relative frequencies of 42 bacterial species in whole saliva samples from 8,173 Kuwaiti adolescents (mean age 10.00 ± 0.67 years) using DNA probe analysis. In addition, clinical data related to obesity, dental caries, and gingivitis were collected. Data were compared between adolescents with high salivary glucose (HSG; glucose concentration ≥ 1.0 mg/d, n = 175) and those with low salivary glucose (LSG, glucose concentration < 0.1 mg/dL n = 2,537). RESULTS:HSG was associated with dental caries and gingivitis in the study population. The overall salivary bacterial load in saliva decreased with increasing salivary glucose concentration. Under HSG conditions, the bacterial count for 35 (83%) of 42 species was significantly reduced, and relative bacterial frequencies in 27 species (64%) were altered, as compared with LSG conditions. These alterations were stronger predictors of high salivary glucose than measures of oral disease, obesity, sleep or fitness. CONCLUSIONS:HSG was associated with a reduction in overall bacterial load and alterations to many relative bacterial frequencies in saliva when compared with LSG in samples from adolescents. We propose that hyperglycemia due to obesity and/or T2D results in HSG and subsequent acidification of the oral environment, leading to a generalized perturbation in the oral microbiome. This suggests a basis for the observation that hyperglycemia is associated with an increased risk of dental erosion, dental caries, and gingivitis. We conclude that HSG in adolescents may be predicted from salivary microbial diversity or frequency, and that the changes in the oral microbial composition seen in adolescents with developing metabolic disease may the consequence of hyperglycemia.

The increasing prevalence of childhood obesity and obesity-related metabolic disorders is now considered a global pandemic. The main goal of the pediatric obesity research community is to identify children who are at risk of becoming obese before their body mass index rises above age norms. To do so, we must identify biomarkers of metabolic health and immunometabolism that can be used for large-scale screening and diagnosis initiatives among at-risk children. Because blood sampling is often unacceptable to both parents and children when there is no direct benefit to the child, as in a community-based research study, there is a clear need for a low-risk, non-invasive sampling strategy. Salivary analysis is now well recognized as a likely candidate for this purpose. In this review, we discuss the physiologic role of saliva and its strengths and limitations as a fluid for biomarker discovery, obesity screening, metabolic disease diagnosis, and response monitoring after interventions. We also describe the current state of the salivary biomarker field as it pertains to metabolic research, with a special emphasis on studies conducted in children and adolescents. Finally, we look forward to technological developments, such as salivary "omics" and point of service diagnostic devices, which have the potential to accelerate the pace of research and discovery in this vitally important field.

PURPOSE:To evaluate sealant retention in a multi-operator school-based oral health programme and sealant efficacy in preventing caries in a high caries-risk population.MATERIALS AND METHODS:Sealant retention and caries status in previously placed sealants on permanent first molars were evaluated in 503 children ages 6 to 8 years at 20 primary schools. A total of 2538 sealants were applied on 876 first permanent molars and evaluated for retention and efficacy in preventing caries from 2002 to 2007. These sealants were placed on occlusal and buccal or palatal surfaces using a standard protocol after isolation with rubber-dam or cotton roll. Caries was scored in teeth in which the sealants were partially or completely lost.RESULT:1752 sealants (69%) were examined at the end of the fifth year, with 58.3% of the sealants completely retained, 7.4% partially lost, 19% completely lost, 6.2% resealed and 9.1% restored. Only 3.1% of the previously sealed teeth were carious and 87.8% of previously sealed teeth were caries free. In multivariate analysis, occlusal surfaces were 2.0 times more likely to retain a sealant than were the buccal and palatal pits (p < 0.0001). No differences in sealant retention vs caries by arch, or teeth isolated using rubber-dam vs cotton roll were seen.CONCLUSION:The present study shows the effectiveness of sealants in caries prevention in a multi-operator school sealant programme, and provides evidence supporting their use in such programmes for high-caries populations.

PURPOSE:To measure oral health (OH) knowledge, attitude and practices (KAP) of primary school teachers and to evaluate the relationship between these measures and oral health-related quality of life (OHRQoL). MATERIALS AND METHODS:A total of 1013 school teachers from all regions of Kuwait were randomly selected in this cross-sectional study. A questionnaire on demographics, knowledge, attitude, practices and OHRQoL was used. Frequencies and means (SD) were used for data description. Correlations between KAP and OHRQoL were evaluated using Pearson's correlation coefficient. Associations between practice-specific knowledge and its corresponding practice as well as knowledge and practices and OHRQoL were determined using the chi-squared test. RESULTS:About 71% of the participants were females, 57% were 30-50 years old, and 75% had a college education. The mean (95%CI) knowledge score was 60.2% (57.2-62.0), ranging from 15.4% to 93%. The well-known OH facts were the importance of brushing twice a day with fluoridated toothpaste, the cariogenic effect of sticky, sugary foods and snacks, as well as the damage that soft drinks can cause to teeth. The least known facts were replacement frequency of toothbrush, parent's supervision of children's brushing and the benefit of regular flossing. Weak but significant correlations were found between KAP components and OHRQoL (p < 0.05). All practice-specific OH knowledge was significantly associated with its practice, except brushing and flossing (p > 0.05). Self-esteem was the mostly frequently affected OHRQoL construct by improper OH practices. CONCLUSION:Oral health knowledge by itself is not enough to change improper OH practices. Developing behaviourchanging interventions based on OHRQoL outcomes may be beneficial.

OBJECTIVE:Here, we investigated the relationships between obesity and the salivary concentrations of insulin, glucose, and 20 metabolic biomarkers in Kuwaiti adolescents. Previously, we have shown that certain salivary metabolic markers can act as surrogates for blood concentrations.METHODS:Salivary samples of whole saliva were collected from 8,317 adolescents. Salivary glucose concentration was measured by a high-sensitivity glucose oxidase method implemented on a robotic chemical analyzer. The concentration of salivary insulin and 20 other metabolic biomarkers was assayed in 744 randomly selected saliva samples by multiplexed bead-based immunoassay.RESULTS:Obesity was seen in 26.5% of the adolescents. Salivary insulin predicting hyperinsulinemia occurred in 4.3% of normal-weight adolescents, 8.3% of overweight adolescents, and 25.7% of obese adolescents (p < 0.0001). Salivary glucose predicting hyperglycemia was found in only 3% of obese children and was not predictive (p = 0.89). Elevated salivary glucose and insulin occurring together was associated with elevated vascular endothelial growth factor and reduced salivary interleukin-12.CONCLUSION:Considering the surrogate nature of salivary insulin and glucose, this study suggests that elevated insulin may be a dominant sign of metabolic disease in adolescent populations. It also appears that a proangiogenic environment may accompany elevated glucose in obese adolescents.

The prevalence of obesity in Kuwaiti children is among the highest in the world.The aims of this study were to assess the role of short sleep duration as a risk factor in increasing abdominal obesity among Kuwaiti children, and to identify life style habits that contribute to sleep and obesity in this population.Waist circumference (WC) measurements, sleep evaluation interviews, and life style habits were collected from 8,371 children (10 y) from 185 schools representing all of the six governorates of Kuwait.Multivariate linear regression models were constructed to determine two different continuous outcomes; WC and daily sleep hours.Independent variables included TV and videogame use, difficulty breathing at night, participating in sports programs, and diabetic parents, adjusting for snacking, gender, and governorate.Short sleep duration was significantly associated with increased WC in Kuwaiti children (P<0.001).No significant association was detected between obesity and difficulty breathing at night (P=0.4).Watching TV or playing videogames before bedtime, as well as having TV in the bedroom were significant factors related to decreased sleep duration among Kuwaiti children (P<0.001).Short sleep duration is a significant risk factor that increased abdominal obesity among Kuwaiti children.Additionally, it was found that TV and videogame use were major risk factors contributing to decreased sleep duration and increased obesity among this population.

BACKGROUND:Binary definitions of the metabolic syndrome based on the presence of a particular number of individual risk factors are limited, particularly in the pediatric population. To address this limitation, we aimed at constructing composite and continuous metabolic syndrome scores (cmetS) to represent an overall measure of metabolic syndrome (MetS) in a large cohort of metabolically at-risk children, focusing on the use of the usual clinical parameters (waist circumference (WC) and systolic blood pressure (SBP), supplemented with two salivary surrogate variables (glucose and high density lipoprotein cholesterol (HDLC). Two different approaches used to create the scores were evaluated in comparison.METHODS:Data from 8,112 Kuwaiti children (10.00 ± 0.67 years) were used to construct two cmetS for each subject. The first cmetS (cmetS-Z) was created by summing standardized residuals of each variable regressed on age and gender; and the second cmetS (cmetS-PCA) was defined as the first principal component from gender-specific principal component analysis based on the four variables.RESULTS:There was a graded relationship between both scores and the number of adverse risk factors. The areas under the curve using cmetS-Z and cmetS-PCA as predictors for severe metabolic syndrome (defined as the presence of ≥3 metabolic risk factors) were 0.935 and 0.912, respectively. cmetS-Z was positively associated with WC, SBP, and glucose, but inversely associated with HDLC. Except for the lack of association with glucose, cmetS-PCA was similar to cmetS-Z in boys, but had minimum loading on HDLC in girls. Analysis using quantile regression showed an inverse association of fitness level with cmetS-PCA (p = 0.001 for boys; p = 0.002 for girls), and comparison of cmetS-Z and cmetS-PCA suggested that WC and SBP were main contributory components. Significant alterations in the relationship between cmetS and salivary adipocytokines were demonstrated in overweight and obese children as compared to underweight and normal-weight children.CONCLUSION:We have derived continuous summary scores for MetS from a large-scale pediatric study using two different approaches, incorporating salivary measures as surrogate for plasma measures. The derived scores were viable expressions of metabolic risk, and can be utilized to study the relationships of MetS with various aspects of the metabolic disease process.

Background Metabolic syndrome in childhood predicts the development of cardiovascular disease and type 2 diabetes (T2D) in adulthood. Testing for features of metabolic syndrome, such as fasting plasma glucose concentration, requires blood sampling which can be difficult in children. Here we evaluated salivary glucose concentration as a surrogate measurement for plasma glucose concentration in 11-year-old US children. Methods Children from Portland, Maine, and Cambridge, Massachusetts, with a mean age of 10.6±0.2 years provided 6-hour fasting samples of both blood and whole saliva. Salivary glucose levels were measured with a high-sensitivity assay (sensitivity =0.002 mg/dL). Plasma glucose levels were determined by a commercial clinical laboratory. Blood pressure, salivary flow rate, height, and weight were also measured. Results Of the 65 children enrolled, there were two underweight children (3.1%), 30 normal-weight children (46.2%), 12 overweight children (18.4%), and 21 obese children (32.3%). The mean overall glucose concentrations were 0.11±0.02 mg/dL in saliva and 86.3±0.8 mg/dL in plasma, and these did not differ significantly by body–weight groups. By regression analysis, the plasma concentration equaled 13.5 times the saliva concentration, with a threshold level of 84.8 mg/dL. Salivary glucose values less than threshold plasma concentration were essentially zero. Diagnostic analysis indicated a positive predictive value of 50%, a negative predictive value of 90%, and a sensitivity and specificity both of approximately 75%. The salivary glucose concentration did not vary with saliva flow rate. Conclusion Taking into account the threshold response characteristics of the salivary glucose concentration response, these results suggest that testing salivary glucose levels may be useful as a screening assay for high fasting plasma glucose levels. The low false positive value is important to assure a low fraction of missed diagnoses.

Objective: The study of obesity-related metabolic syndrome or Type 2 diabetes (T2D) in children is particularly difficult because of fear of needles. We tested a non-invasive approach to study inflammatory parameters in an at-risk population of children to provide proof-of-principle for future investigations of vulnerable subjects.Design and Methods: We evaluated metabolic differences in 744, 11-year old children selected from underweight, normal healthy weight, overweight and obese categories by analyzing fasting saliva samples for 20 biomarkers. Saliva supernatants were obtained following centrifugation and used for analyses.Results: Salivary C-reactive protein (CRP) was 6 times higher, salivary insulin and leptin were 3 times higher, and adiponectin was 30% lower in obese children compared to healthy normal weight children (all P<0.0001). Categorical analysis suggested that there might be three types of obesity in children. Distinctly inflammatory characteristics appeared in 76% of obese children while in 13%, salivary insulin was high but not associated with inflammatory mediators. The remaining 11% of obese children had high insulin and reduced adiponectin. Forty percent of the non-obese children were found in groups which, based on biomarker characteristics, may be at risk for becoming obese.Conclusions: Significantly altered levels of salivary biomarkers in obese children from a high-risk population, suggest the potential for developing non-invasive screening procedures to identify T2D-vulnerable individuals and a means to test preventative strategies.