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Boston researchers work toward a saliva test for diabetes risk

Dr. Max Goodson envisions a future in which dentists performing a routine cleaning will take a quick saliva sample to determine whether a child is at risk for type 2 diabetes, providing an early alert that could help prevent full-blown disease.

Goodson and colleagues from the Forsyth Research Institute, a Cambridge nonprofit focused on oral health research, reported a step toward that goal Tuesday with the discovery that obese children have markedly different levels of four molecules in their saliva compared with normal-weight children.

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The data, published in the journal PLOS ONE, provide an early hint that a range of molecules measured in saliva might be useful in screening for metabolic disease.

Much work remains to be done to see whether the biomarkers are actually predictive of developing diabetes, work that Goodson hopes to continue by following the children in the study and by launching another study with researchers at Boston University.

“There’s definite evidence there are children who have obesity that really represents metabolic disease and other children who have obesity that doesn’t seem to be related to a disease condition other than the fact that they’re overweight,” Goodson said. “The difference is actually inflammation.”

The study illustrates the value of studying large populations over long time periods, in this case enabled by Forsyth’s longstanding partnership with the government of Kuwait. Goodson said he was partially inspired by the Framingham Heart Study, which has followed thousands of individuals over decades, yielding insight into the causes of heart disease. Five years ago, Goodson saw a similar opportunity in Kuwait, which was dealing with type 2 diabetes in part because of the recent introduction of a more Westernized diet and fast-food companies.

“Having access to half a million children would be an enormous opportunity to begin to investigate some of the causes of this incredible disease problem, that has been sweeping the earth, of adolescent obesity,” Goodson said.

Forsyth collaborates with the government on the Kuwait Healthy Life Study, and in 2011 examined 8,400 children, gathering information including height, weight, blood pressure, fitness, sleep habits, and diet, and collecting saliva. The team analyzed a subset of 744 11-year-olds to learn which molecules in saliva were elevated or unusually low in obese children. The researchers followed up, gathering data on 6,500 of them on a recent visit, and will continue to study the data to better understand the causes of obesity and possible early-warning signs of type 2 diabetes.

Dr. Robert Gabbay, chief medical officer at the Joslin Diabetes Center, who was not involved in the research, said that a noninvasive screening tool for type 2 diabetes could be valuable because of the difficulty of taking blood samples from children.

The true value of the saliva test might be in helping to reveal the biology underlying obesity and metabolic disease.

“If it’s really validated, it could be a very interesting research tool,” Gabbay said. “One could study large numbers of children and understand a lot more of the physiology of what’s going on with obesity.”

Carolyn Y. Johnson can be reached at Follow her on Twitter @carolynyjohnson.
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