Relationship of Early Childhood Protein-Energy Malnutrition and salivary gland hypofunction

Objective: The purpose of this study was to determine the relationship between Early Childhood Protein-Energy Malnutrition (EC-PEM) and salivary gland hypofunction. Methods: The study was conducted using measurements of weight-for-age on children from birth to five years old with at least 2 weighings in three of their first 5 years of life and converted to z-scores based on the World Health Organization (WHO) 1978 reference data base. Three categories of exposure were created: 1) No Malnutrition: z-score> -1; 2) Questionable Malnutrition z-score ≤ -1 and >-2; and, 3) Severe Malnutrition z-score ≤ -2. Oral clinical examinations using WHO diagnostic criteria, saliva secretion rate using the Malmo University protocol and pH measurement using the Dentobuff® Strip System were conducted on 1,058 rural Haitian children ages 11 to 19 in 2005, with complete data for analysis on 1,023 children. Multivariate analyses (MANOVA) were conducted to examine the relationships between unstimulated and stimulated saliva secretion rates and saliva pH, and the independent variables age, gender and EC-PEM. Results: The mean age of the subjects was 13.9 years (SD 1.7) and 54% of the subjects were males. The MANOVA Pillai's Trace test demonstrated statistical significance for nutrition status and age. Stimulated saliva flow and stimulated and unstimulated pH scores demonstrated statistically significant inverse relationships with severity of malnutrition. No difference was found for unstimulated pH values. Conclusions: Based on the results from this sample, we conclude that there is an association between severe EC-PEM and reduced saliva secretion rates as well as minimized buffering capacity in stimulated saliva. These results are consistent with the few reported findings in the literature, and suggests a biological mechanism, salivary hypofunction, which might explain the relationship between EC-PEM and dental caries.

Supported by NIH NIDCR R01 DE014708-01A2