Obesity, Type 2 Diabetes, and Oral Health in Appalachian Children

Recent national reports describe an “epidemic” of obesity and T2DM in adolescents. Increasing prevalence is coincident with a more sedentary lifestyle and poor nutritional habits of US youths, particularly represented in minority and rural populations. It has been clearly demonstrated that obesity and T2DM are linked to poor oral health, ie. periodontitis, in adults. OBJECTIVE: This study used a school-linked mobile dental outreach program to document the prevalence of obesity and risk of T2DM in rural Kentucky children. METHODS: A surveillance program that evaluated oral health in 1st – 5th grade children for their need for dental care was used to implement this project. The height/weight (BMI) and waist and hip circumferences, combined with family data were collected from the same cohort of children and used to estimate T2DM risk. RESULTS: 540 children have been screened. 47% of the rural children were Medicaid/KCHIP eligible and 32% were uninsured. The oral health evaluation determined that 42% had urgent or early dental treatment needs. Across 4 elementary schools, 36-49% of the children were estimated to be at risk for T2DM based upon falling into a >85th percentile of body measures. High risk children are being further evaluated for detailed periodontal measures, finger stick blood samples for glucose and HbA1c, and whole saliva measures for diabetic biomarkers. Those demonstrating altered biological markers of diabetes are incorporated into an adolescent diabetes monitoring/intervention program. CONCLUSIONS: This project has implemented a unique model for identifying early risk markers for T2DM in adolescents. The early findings indicated a high risk rate for T2DM in rural children, accompanied by generally poor oral health. Effective oral and general health intervention strategies need to be developed to minimize the potential synergism of these diseases leading to chronic and potentially debilitating health problems in this vulnerable population. Supported by HRSA 1 D1ARH0565653-01-00