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Community and Public Health Nutrition (Poster Session)

(P20-093-24) Effects of Drinking Water Instead of Apple Juice or No Drink on Saliva Insulin Vary by Child Weight Status

Monday, July 1, 2024
12:45 PM – 1:45 PM CT
Location: Poster Board 583

    Presenting Author(s)

  • JS

    Jodi Stookey, PhD

    MCAH Senior Epidemiologist
    San Francisco Department of Public Health
    San Francisco, California, United States

  • JS

    Jodi Stookey, PhD

    MCAH Senior Epidemiologist
    San Francisco Department of Public Health
    San Francisco, California, United States

    • Co-Author(s)

  • MC

    Mimansa Cholera

    University of California, San Francisco, United States

  • MC

    Mimansa Cholera

    University of California, San Francisco, United States

  • RC

    Rowena Cape

    San Francisco Department of Public Health, United States

  • RC

    Rowena Cape

    San Francisco Department of Public Health, United States

Disclosure(s):
Jodi Stookey, PhD: No relevant financial relationship(s) with ineligible companies to disclose.


Objectives: Health authorities recommend drinking water intervention, in childhood, to prevent progressive dysglycemia and diabetes incidence. Gaps in surveillance data about diabetes risk in children, reflecting stigma and fear of blood tests, limit intervention design. To enable intervention planners to use saliva insulin to tailor eligibility criteria and evaluation goals, without input about weight or blood tests, this secondary analysis of data from the Saliva Insulin as Biomarker study (NCT05211843) aimed to determine if drinking water intervention effect significance, magnitude of effect, and/or threshold for effect depend on weight status.

Methods: After baseline saliva collection,105 pediatric patients (5-10y), attending a routine dental check-up, were randomly assigned to receive a standard serving of water (W) or apple juice (AJ), or no drink (ND). Randomization was stratified by normal weight (NWT) (n=60) or overweight or obese (OWT) (n=45) (BMI < , >=85th percentile) condition. Follow-up saliva was collected 45-60 min after drink administration. Results from weight-stratified logistic regression models were compared.

Results: Baseline random saliva insulin ranged from 6-960 pg/mL and 28-5070 pg/mL for NWT and OWT, respectively. Random assignment to W instead of AJ or W instead of ND was associated with significantly reduced risk of saliva insulin over 170 pg/mL at 45-60 min for the NWT condition only. For the OWT condition, magnitudes of effect were weaker by about half (W vs. AJ, OR: 0.18, 95%CI: 0.03-1.07 vs OR: 0.06, 95%CI: 0.01-0.29 for NWT; W vs. ND, OR: 0.29, 95%CI: 0.06-1.45 vs. OR: 0.14, 95%CI: 0.04-0.57 for NWT). Following W: saliva insulin decreased by a median of 24% relative to baseline for OWT vs. 38% for NWT;  the 75th percentile of saliva insulin at 45-60 min was 548 pg/mL for OWT and 200 pg/mL for NWT.

Conclusions: Differences in saliva insulin range and response to drinking water intervention by weight condition may inform intervention eligibility criteria, target effect size and/or threshold.

Funding Sources: The Saliva Insulin as Biomarker project was made possible by California Society Pediatric Dentistry, Drinking Water Research Foundation, UCSF CTSI Lab Grant # UL1TR001872, and the San Francisco Public Health Foundation.