Estimation of salivary amylase in diabetic patients and saliva as a diagnostic tool in early diabetic patients

A Determination of Salivary and Serum Glucose Levels in Patients With Type II Diabetes Mellitus

AIM

The aim of this work was to determine and compare serum and salivary glucose levels in patients with type II diabetes mellitus (DM).

MATERIAL AND METHODS

This study had an overall sample size of 100, which consisted of male and female volunteers aged 30-67 years. Both in-depth interviews and physical tests were conducted. Blood and saliva were collected from the participants while fasting, which were analyzed to determine the levels of salivary alpha-amylase (α-amylase). Both the subjects and the controls were instructed to test their blood glucose levels while fasting and it was suggested that HbA1c values will be used for diagnosing diabetes following the guidelines of the American Diabetes Association, Centers for Disease Control, and World Health Organization.

RESULTS

The average age of the control group (Category A) was noted as 47.52±6.28 years, and that of the study group (Category B) was 49.17±7.25 years. In Category A, female (n=23) were 46%, and 54% were male (n=27); and 40% of the people in Category B were female (n=20), and 60% were male (n=30). The majority of patients (54%) in Category B displayed an average level of DM control (n=27), followed by poor control (24%. n=12), well-controlled (20%, n=10), and uncontrolled DM (2%, n=1). Category A had an average salivary α-amylase concentration of 3.1±0.88 U/L, whereas that of Category B was 12.06±2.36 U/L. Thus, the mean salivary α-amylase level of Category B was found to be much higher than that of Category A, and this difference was statistically significant (p<0.001).

CONCLUSION

The determination of α-amylase levels in the saliva of individuals suspected of having type II DM has been suggested as a potential diagnostic method. Screenings conducted at healthcare institutions and community health fairs, as well as epidemiological studies, might benefit from this method. We believe that normal clinical practice should include the use of saliva in a broad variety of diagnostic tests.

Efficacy of nonsurgical periodontal therapy affecting salivary biomarkers in non-diabetic and type 2 diabetic periodontitis patients. An observational study

Objectives

To assess the effects of non-surgical periodontal therapy on salivary biomarkers in non-diabetic and type 2 diabetic periodontitis patients and to investigate if saliva may be used to monitor glucose levels in type 2 diabetes.

Material and methods

250 participants with chronic generalized periodontitis aged 35-70 years were divided into two groups: test group with type 2 diabetes (125 subjects with 64 males & 61 females) and control group with non-diabetic (125 subjects with 83 males & 42 females). Participants received non-surgical periodontal treatment. Pre-NSPT and 6-week post-NSPT saliva glucose, amylase, total protein, and C-reactive protein (CRP) levels were measured. Intergroup correlations were assessed using Karl Pearson's correlation coefficient and paired t-test.

Results

Non-surgical periodontal therapy significantly decreased CRP (p < 0.05) in diabetics and non-diabetics. CRP mean values changes from baseline 1.79 to post op 1.5 and baseline 1.5 to post-op 1.24 in males and females of test group, respectively. In control group males and females, mean values change from baseline 1.48 to post-op 1.42 and 1.499 to 1.40. Other parameters Glucose, amylase & total protein showed improvement in the level, but statistically non-significant (p > 0.05). Salivary glucose levels corresponded favorably with HbA1C levels.

Conclusion

In individuals with type 2 diabetes and non-diabetic generalized chronic periodontitis, non-surgical periodontal therapy may play a role in lowering the level of significant salivary biomarkers. Saliva can be utilized as a non-invasive approach for monitoring glucose levels in people with type 2 diabetes and chronic periodontitis.

Salivary Biomarkers Associated with Psychological Alterations in Patients with Diabetes: A Systematic Review

The care of individuals with diabetes needs a holistic perspective, taking into account both the physical disease and the mental health problems that may be associated. Different studies show a higher prevalence of depression or anxiety issues in diabetes patients than in the general population, which is why diabetes can be considered one of the chronic diseases in which psychological care is crucial to maintain quality of life. The objective of this review is to examine the published articles that relate the bidirectional associations between objective and subjective measures of anxiety, depressive symptomatology, stress, sleep quality, and salivary biomarkers in patients with diabetes. For this, a search was carried out in the electronic databases PubMed, Cochrane, and SCOPUS using the keywords "diabetes", "saliva", "sleep", "anxiety", "depression", and "stress" for works published up until May 2022 and limited to the English and Spanish languages. The sample comprised 14 articles, 5 of which analysed the associations between depressive symptomatology and salivary biomarkers in people with diabetes. Among the salivary biomarkers most frequently used to evaluate psychological alterations in persons with diabetes are cortisol and melatonin. Thus, significant changes in the levels of these biomarkers were observed in most studies. Four out of five studies reported a statistically significant relationship between increased salivary cortisol in the evening/midnight or the cortisol awakening response and depressive symptoms. In contrast, lower cortisol levels upon waking in the morning were observed when there was no depression or anxiety. Regarding the association between salivary cortisol values and sleep quality in patients with diabetes, lower morning cortisol values related to prolonged nighttime sleep were common in the analysed studies. Low melatonin concentrations showed a negative correlation with sleep quality. As it is an easy-to-apply and non-invasive method, the measurement of salivary biomarkers can be very useful for predicting psychological alterations in patients with diabetes. Further scientific studies are required to determine the sensitivity of these biological substances acting as biomarkers for detecting sleep disorders and psychological alterations.

Changes in salivary biomarkers associated with periodontitis and diabetic neuropathy in individuals with type 1 diabetes

The objective of this pilot clinical study was to identify salivary biomarkers that are associated with periodontal disease and measures of diabetic autonomic dysfunction. Saliva samples from 32 participants were obtained from 3 groups: healthy (H), type 1 diabetes mellitus (DM), and type 1 diabetes mellitus with neuropathy (DMN). Based on the periodontal examination, individuals’ mean Periodontal Screening and Recording scores were categorized into two groups (periodontally healthy and gingivitis), and correlated to specific salivary inflammatory biomarkers assessed by a customized protein array and enzyme assay. The mean salivary IgA level in DM was 9211.5 ± 4776.4 pg/ml, which was significantly lower than H (17,182.2 ± 8899.3 pg/ml). IgA in DMN with healthy periodontium was significantly lower (5905.5 ± 3124.8 pg/ml) compared to H, although IgA levels in DMN patients with gingivitis (16,894. 6 ± 7084.3) were not. According to the result of a logistic regression model, IgA and periodontal condition were the indicators of the binary response given by H versus DM, and H versus DMN, respectively. These data suggest that selected salivary biomarkers, such as IgA, combined with a periodontal examination prior to obtaining salivary samples can offer a non-invasive method to assess risk for developing diabetic neuropathy.

Potential Roles of α-amylase in Alzheimer's Disease: Biomarker and Drug Target

Alzheimer's disease (AD), the most common form of dementia, is pathologically characterized by the deposition of amyloid-β plaques and the formation of neurofibrillary tangles. In a neurodegenerative brain, glucose metabolism is also impaired and considered as one of the key features in AD patients. The impairment causes a reduction in glucose transporters and the uptake of glucose as well as alterations in the specific activity of glycolytic enzymes. Recently, it has been reported that α-amylase, a polysaccharide-degrading enzyme, is present in the human brain. The enzyme is known to be associated with various diseases such as type 2 diabetes mellitus and hyperamylasaemia. With this information at hand, we hypothesize that α-amylase could have a vital role in the demented brains of AD patients. This review aims to shed insight into the possible link between the expression levels of α-amylase and AD. Lastly, we also cover the diverse role of amylase inhibitors and how they could serve as a therapeutic agent to manage or stop AD progression.

Salivary alpha-amylase-biomarker for monitoring type II diabetes

Background:

Diabetes is one of the most important causes of mortality worldwide. People having diabetes are vulnerable to infectious diseases and have been clinically recognized; which may be because of their deregulated immune system. Hyperglycemia in diabetes is consequence of chronic resistance to insulin and relative insulin deficiency on target cells. Alpha-amylase, a salivary enzyme is shown to increase in diabetic individuals compared to nondiabetics and can be used as a marker for the diagnosis of diabetes.

Aim and Objective:

The present study was undertaken to investigate the levels of salivary amylase in type II diabetic patients.

Materials and Methods:

A total of 80 participants in the age range of 30–60 years, were divided into three groups as Group I: Uncontrolled diabetics (30), Group II: Controlled diabetics (30) and Group III: Age- and sex-matched healthy controls (20) were taken for the study. Unstimulated whole saliva was collected for salivary amylase level estimation and blood samples were from the antecubital vein, after 12 h of overnight fasting of each individual for the estimation of blood glucose levels.

Results:

The mean random blood sugar and glycated hemoglobin A_1c levels were found to be statistically significant among diabetics and healthy individuals. Salivary amylase levels were much higher in uncontrolled and controlled diabetics compared to healthy individuals showing a significant correlation (P = 0.001) between all groups. However, the salivary amylase levels nonsignificant (P = 0.060) between the controlled diabetics (Group II) and healthy individuals (Group III).

Conclusion:

Our study confirms the considerable increase in salivary amylase levels in diabetes patients as compared to healthy individuals. Studies with a larger sample size comprising prediabetics, type I diabetics and type II diabetics in all age groups are required to validate these results. Further, if our results are established, salivary amylase can be used as biomarker for the diagnosis of diabetes and also monitoring it.

Salivary gland proteins alterations in the diabetic milieu

Salivary glands are considered the chief exocrine glands of the mouth and physiologically contribute to the maintenance of the homeostasis of the oral cavity. They consist of the parotid, submandibular and sublingual glands, which come in pairs and are collectively called the major glands, and the minor glands, which are much smaller and are dispersed throughout the buccal cavity. Salivary glands are distinguished by their size, amount of saliva secretion and their location in the oral cavity. Salivary glands pathophysiology has been a subject of interest in various worldwide metabolic disorders, including diabetes mellitus. Diabetes mellitus (DM), a global health concern, with a pathological imprint involved in vasculature, promotes microvascular and macrovascular complications among which periodontitis ranks sixth. Indeed, DM has also been directly associated with oral health lesions. Specifically, salivary glands in the context of diabetes have been a focal point of study and emphasis in the research field. There is evidence that relates salivary secretion content and diabetes progression. In this review, we present all the reported evidence of the deregulation of specific salivary proteins associated with the progression of diabetes in parallel with changes in salivary gland morphology, cellular architecture, and salivary secretion and composition more generally.

Changes in Salivary Amylase and Glucose in Diabetes: A Scoping Review

BACKGROUND AND OBJECTIVE

Diabetes mellitus (DM) is a common long-term disease which can be related with salivary amylase levels. DM has recently been associated with salivary amylase diagnostics that could further impair diagnoses in the diabetic population, as well as being an interesting alternative to traditional methods of determine glucose levels. The main advantage of this method is related to the fact that it is a fast diagnostic method. The DM population experiences changes to their metabolism which affects their salivary parameters, making this an alternative procedure for diagnosis and follow-up of the illness due to the non-invasive nature of salivary analyzes. The objective of this review is to summarize the evidence regarding the changes in salivary amylase and glucose levels, and their relationship with blood markers of glycemic control used in clinical settings such as blood glucose and glycated hemoglobin. The differences in salivary amylase levels depending on the method of saliva collection under fasting or non-fasting conditions. The changes in salivary amylase depends on the type of diabetes, the type of insulin treatment or the quality of glycemic control.

CONCLUSIONS

Salivary amylase concentration is increased in diabetic patients in most of the studies and salivary glucose concentration in all studies in both fasting and non-fasting (post-prandial) conditions. Salivary amylase and glucose concentration represent potential non-invasive biomarkers to evaluate glycemic control and clinical management of diabetic patients, although it is necessary to evaluate the influence of potential modulating factors such as age, duration diseases, sex and the effects of pharmacological treatments in these outcomes which remained to be elucidated.

Micro/nanodevices for assessment and treatment in stomatology and ophthalmology

Micro/nanodevices have been widely applied for the real-time monitoring of intracellular activities and the delivery of exogenous substances in the past few years. This review focuses on miniaturized micro/nanodevices for assessment and treatment in stomatology and ophthalmology. We first summarize the recent progress in this field by examining the available materials and fabrication techniques, device design principles, mechanisms, and biosafety aspects of micro/nanodevices. Following a discussion of biochemical sensing technology from the cellular level to the tissue level for disease assessment, we then summarize the use of microneedles and other micro/nanodevices in the treatment of oral and ocular diseases and conditions, including oral cancer, eye wrinkles, keratitis, and infections. Along with the identified key challenges, this review concludes with future directions as a small fraction of vast opportunities, calling for joint efforts between clinicians and engineers with diverse backgrounds to help facilitate the rapid development of this burgeoning field in stomatology and ophthalmology.

Sialometric and Sialochemical Analysis in Individuals With Pulp Stones

The aim of this study was to analyze the saliva of patients with pulp stones, with sialometric and sialochemical tests. Eighty individuals, aged between18 and 65 years, of both sexes, were investigated. Patients were included in the pulp stone group when radiographic examination was suggestive of pulp stones in at least one permanent tooth, whereas those without this alteration were considered controls. Saliva was collected by stimulation, followed by salivary flowrate (SFR) and pH analysis tests. The organic components, such as urea (URE), glucose (GLU), total proteins (TPTs), alkaline phosphatase, creatinine (CRE), salivary amylase (SAM), and uric acid (URA), and the inorganic components, such as calcium, iron, and phosphorus, were evaluated by colorimetric techniques in an ultraviolet–visible (UV–vis) spectrophotometer. Differences among pulp stones and control groups were compared using Student’s t-test, with a significance level of p < 0.05. In both groups prevailed the female. Statistically significant differences between groups were observed for pH (p = 0.027), SFR (p = 0.002), alkaline phosphatase (p = 0.008), and URA (p = 0.005). None of the inorganic components showed significant difference (p > 0.05). In the analyses stratified by sex, difference between groups was observed for pH (p = 0.007) and URA (p = 0.003) in women. In conclusion, sialometric and sialochemical alterations occurred in patients with pulp stones, with significantly higher levels of pH, SFR, alkaline phosphatase, and URA.

Functional and histological evaluation of bone marrow stem cell-derived exosomes therapy on the submandibular salivary gland of diabetic Albino rats through TGFβ/ Smad3 signaling pathway

BACKGROUND

To prevail over diabetes mellitus and its numerous complications, researchers are seeking new therapies. Exosomes are natural cargo of functional proteins and can be used as a therapeutic delivery of these molecules.

OBJECTIVE

The aim of this study was to evaluate the effect of exosomes derived from bone marrow mesenchymal stem cells (BM-MSCs) as a therapeutic intervention in salivary gland diabetic complications.

METHODS

Ten adult healthy male Albino rats, weighing about 150-200 g were grouped into 2 groups. Diabetic group I: consisted of 5 streptozotocin (STZ)-induced diabetic rats. Exosomes treated group II: consisted of 5 STZ-induced diabetic rats, each animal received a single injection of exosomes (100 μg/kg/dose suspended in 0.2 ml PBS) through the tail vein. All animals were sacrificed after 5 weeks from the beginning of the experiment. Submandibular salivary gland samples were excised and processed for histological, ultrastructural examination and PCR for TGFβ, Smad2 and Smad3. Blood glucose level was monitored weekly, salivary IgA and serum amylase were evaluated before and after diabetes induction and at the end of the experiment.

RESULTS

Histological and ultrastructural results of the exosomes treated group were promising regarding the glandular and ductal elements with less fibrosis observed. Results of PCR supported the role of exosomes to inhibit the diabetic sequalae in salivary gland and its complications through inhibiting TGFβ and its related pathway via Smad2 and Smad3. Blood glucose levels were reduced. In addition, salivary glands' function was improved as evidenced by reduction in serum amylase and salivary IgA.

CONCLUSION

BM-MSC-derived exosomes could be a novel therapeutic strategy for diabetic complications involving salivary glands.

Saliva diagnostic utility in patients with type 2 diabetes: Future standard method

Background

The purpose of the present study was to assess saliva reliability in diagnosis and monitoring type 2 diabetes instead of blood.

Methods

Blood and unstimulated whole saliva were collected from 300 type 2 diabetic subjects and 300 healthy controls in fasting. Then, the salivary flow rate was calculated. All parameters including glucose, urea, amylase, total protein, albumin, C-reactive protein (CRP), immunoglobulin A (IgA), potassium, calcium and chloride were assessed in the supernatant, using an autoanalyzer. Oral exam was conducted by a single examiner on full mouth excluding third molars. Statistical analysis was performed by the SPSS 20.0 version.

Results

Saliva screening showed that glucose, urea, amylase, total protein, potassium, calcium and chloride were significantly higher in patients compared to controls (p < 0.05). Whereas, the IgA level and salivary flow rate were significantly reduced in patients (p < 0.05). No significant difference was found in albumin and CRP levels (p > 0.05). There was a significant positive correlation between salivary and plasma glucose levels (r = 0.887, and r = 0.900, p < 0.001), as well as, salivary and blood urea (r = 0.586, and r = 0.688, p < 0.001) in patients and controls, respectively.

Conclusions

From this study, saliva could be suggested as a useful diagnostic tool for type 2 diabetes.

Association of salivary levels of immunoglobulin-a and amylase with oral-dental manifestations in patients with controlled and non-controlled type 2 diabetes

Background

Oral health is related to general health and one of the most prevalent chronic diseases is diabetes mellitus. Diabetes can have adverse effects on oral health and vice versa. Saliva analysis can be used as a non-invasive method to obtain information about diseases status like diabetes. The aim of present study was to evaluate the salivary immunoglobulin-A (s-IgA) and salivary amylase levels and their associations with oral-dental manifestations in patients with controlled and non-controlled type 2 diabetes.

Methods

This case-control study was carried out on 90 subjects who referred to the Diabetes Center of Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran. Participants were divided into three groups: 1) uncontrolled diabetic patients (n = 30); 2) controlled diabetic patients (n = 30); and 3) healthy individuals (n = 30). Unstimulated salivary levels of I-A and amylase were measured. All participants underwent a dental and periodontal examination to explore the oral and dental manifestations. T-test, chi-square and ANOVA tests were used for data analysis in SPSS 18.

Results

Significant higher level of s-IgA was found in uncontrolled diabetic patients compared to controlled diabetic (P ≤ 0.0001) and the control group (P = 0.004). Moreover, the mean levels of s-amylase in uncontrolled patients was significantly higher compared to controlled diabetic (P = 0.01) and the control group (P ≤ 0.0001). Uncontrolled diabetic patients with oral candidiasis, erythematous candidiasis, abscesses, or xerostomia had higher s-IgA levels compared to the controlled diabetic participants. Moreover, uncontrolled diabetic patients with oral candidiasis or erythematous candidiasis showed a significant higher levels of s-amylase compared to controlled diabetic patients. Also, significant positive correlations were found between s-IgA and DMFT and s-IgA and PDI (r = 0.444, P = 0.014 and r = 0.386, P = 0.035, respectively).

Conclusion

In conclusion, higher s-amylase and s-IgA concentrations may reflect oral-dental manifestations in T2DM. Moreover, the current findings suggest that s-amylase and s-IgA may serve as a complementary and alternative fluid in screening for diabetes mellitus.

Integrating genomic data from high-throughput studies with computational modeling reveals differences in the molecular basis of hyposalivation between type 1 and type 2 diabetes

OBJECTIVES

Both type 1 and type 2 diabetes are accompanied by a high prevalence of hyposalivation (decreased salivary secretion), resulting in oral tissue damage. However, the molecular basis for the hyposalivation is yet unknown. Identifying genes and proteins that account for diabetes-related hyposalivation will help understanding the basis for this condition and identifying disease biomarkers in saliva.

MATERIALS AND METHODS

We integrated genomic data from 110 high-throughput studies with computational modeling, to explore the relationship between diabetes and salivary glands on a genomic scale.

RESULTS

A significant overlap exists between genes that are altered in both types of diabetes and genes that are expressed in salivary glands; 87 type 1 diabetes and 34 type 2 diabetes associated genes are also common to salivary glands. However, the overlap between these genes is not significant.

CONCLUSIONS

Type 1 and type 2 diabetes associated genes are involved in the salivary secretion process, but mostly at different parts of it. This suggests that type 1 and type 2 diabetes impair salivary secretion by affecting different processes in the salivary tissue.

CLINICAL RELEVANCE

The genomic characteristics of Type 1 and type 2 diabetes may explain differences in salivary gland tissues morphology and saliva composition in people with diabetes, and suggest candidate proteins for diabetes salivary biomarkers.

Selection, Characterization and Application of Artificial DNA Aptamer Containing Appended Bases with Sub-nanomolar Affinity for a Salivary Biomarker

We have attained a chemically modified DNA aptamer against salivary α-amylase (sAA), which attracts researchers’ attention as a useful biomarker for assessing human psychobiological and social behavioural processes, although high affinity aptamers have not been isolated from a random natural DNA library to date. For the selection, we used the base-appended base (BAB) modification, that is, a modified-base DNA library containing (E)-5-(2-(N-(2-(N6-adeninyl)ethyl))carbamylvinyl)-uracil in place of thymine. After eight rounds of selection, a 75 mer aptamer, AMYm1, which binds to sAA with extremely high affinity (K_d < 1 nM), was isolated. Furthermore, we have successfully determined the 36-mer minimum fragment, AMYm1-3, which retains target binding activity comparable to the full-length AMYm1, by surface plasmon resonance assays. Nuclear magnetic resonance spectral analysis indicated that the minimum fragment forms a specific stable conformation, whereas the predicted secondary structures were suggested to be disordered forms. Thus, DNA libraries with BAB-modifications can achieve more diverse conformations for fitness to various targets compared with natural DNA libraries, which is an important advantage for aptamer development. Furthermore, using AMYm1, a capillary gel electrophoresis assay and lateral flow assay with human saliva were conducted, and its feasibility was demonstrated.

Estimation of Salivary and Serum Biomarkers in Diabetic and Non Diabetic Patients - A Comparative Study

INTRODUCTION

Blood is the gold standard body fluid for diagnosis of Diabetes Mellitus (DM) but saliva offers an alternative to serum as a biological fluid for diagnostic purposes because it contains serum constituents.

AIM

The study was conducted to estimate and compare serum and salivary glucose, amylase, proteins, calcium and phosphorus levels in DM and healthy subjects and to evaluate whether saliva can be used as a diagnostic fluid in DM patients.

MATERIALS AND METHODS

Study consisted of 120 subjects from OPD of Surendera Dental College, Sriganganagar, Rajasthan, India. The study groups were divided into Group I-60 DM patients (Type I & II) and Group II-60 healthy subjects. The saliva and serum samples were collected from each subject and levels of different biochemical parameters were estimated.

RESULTS

Mean serum level of glucose (211.50 ± 43.82), amylase (79.86 ± 16.23), total proteins (6.65 ± 0.84), calcium (7.17 ± 0.91) and phosphorus (3.68±0.65) as observed in Group I while in Group II, glucose (88.81±11.29), amylase (77.67±14.88), total proteins (6.35±0.76), calcium (7.52±0.97) and phosphorus (3.96 ± 0.91) were noted. Mean salivary level of glucose (14.10±6.99), amylase (1671.42±569.86), total proteins (1.33±1.11), calcium (10.06±2.76) and phosphorus (13.75±4.45) as observed in Group I while in Group II, glucose (5.87± 2.42), amylase (1397.59 ±415.97), total proteins (1.36±0.81), calcium (7.73±2.78) and phosphorus (8.39 ± 1.95) were noted. On comparing values in saliva and serum, among two groups, an insignificant difference (p>0.005) was found between few of them.

CONCLUSION

Values regarding blood and salivary biochemical parameters were distinctly different between two groups suggesting salivary parameters can be used as a diagnostic alternative to blood parameters for diabetes mellitus.

Changes in the salivary protein profile of morbidly obese women either previously subjected to bariatric surgery or not

Saliva is a non-invasive source of biomarkers useful in the study of physiological mechanisms. Moreover, this fluid has diverse functions, among which food perception and ingestion, making it particularly suitable for the study of obesity. The aims of this study were to assess changes in salivary proteome among morbidly obese women, with a view to provide information about mechanisms potentially related to the development of obesity, and to evaluate whether these changes persist after weight loss. Mixed saliva samples from morbidly obese women (N = 18) who had been either subjected (group O-BS) or not (group O) to bariatric surgery and women with normal weight (N = 14; group C) were compared for protein profiles, alpha-amylase abundance and enzymatic activity, and carbonic anhydrase (CA) VI abundance. Differences in salivary obese profiles were observed for 23 different spots. Zinc-alpha-2 glycoprotein-containing spots showed higher abundance in group O only, whereas cystatin S-containing spots presented higher abundance in the two groups of obese subjects. Most of the spots identified as salivary amylase were present at lower levels in group O-BS. With regard to the amylase enzymatic activity, increases were observed for group O and decreases for group O-BS. One interesting finding was the high correlation between levels of CA VI and body mass index in group O, which was not observed for groups O-BS or C. The differences between groups, mainly regarding salivary proteins involved in taste sensitivity and metabolism, point to the potential of using saliva in the study of obesity development.