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. 2012:4.
doi: 10.3402/jom.v4i0.19013. Epub 2012 Oct 30.

The oral microflora in obesity and type-2 diabetes

Edward Shillitoe  1 , Ruth Weinstock, Taewan Kim, Howard Simon, Jessica Planer, Susan Noonan, Robert Cooney
Affiliations

The oral microflora in obesity and type-2 diabetes

Edward Shillitoe et al. J Oral Microbiol. 2012.

Abstract

Background: Type 2 diabetes mellitus (T2DM) is prevalent in people with obesity. It has been proposed that these conditions are related to specific features of the microflora of the mouth and lower gastrointestinal (GI) tract. Hyperglycemia often resolves quickly after Roux-en-Y gastric bypass (RYGB) but the role of the GI microflora cannot be examined easily because of reduced intestinal mobility. We propose that the study of microorganisms present in the mouth of patients undergoing RYGB will contribute to our understanding of the role of bacteria in the pathogenesis of T2DM.

Objective: To conduct a feasibility study to examine differences in oral microbes in obese patients with and without T2DM and to determine whether it is feasible to measure changes after gastric bypass surgery.

Methods: Individuals with morbid obesity (n=29), of whom 13 had T2DM, were studied. Oral rinses, stool samples, and blood samples were obtained before RYGB, and oral rinses and blood samples were obtained at 2 and 12 weeks postsurgery.

Results: Prior to surgery, participants with T2DM had slightly higher total levels of oral bacteria than those without diabetes. Those with HbA1c > 6.5% had rather lower levels of Bifidobacteria in the mouth and stool. At 2 weeks post-RYGB, patients with T2DM were able to reduce or discontinue their hypoglycemic medications. Stool samples could not be obtained but oral rinses were readily available. The levels of oral Bifidobacteria had increased tenfold and levels of circulating endotoxin and tumor necrosis factor-alpha had decreased.

Conclusions: The study of oral bacteria before and after RYGB is feasible and should be tested in larger patient populations to increase our understanding of the role of microorganisms in the pathogenesis of obesity and T2DM.

Keywords: Bifidobacteria; gastric bypass; obesity; oral microflora; type-2 diabetes.

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Figures

Fig. 1
Fig. 1
BMI and HbA1c. Effect of RYGB on BMI in all subjects (A) and on HbA1c levels in subjects with T2DM (B). *p<0.05, **p<0.01, ***p<0.001.
Fig. 2
Fig. 2
Inflammatory markers. Serum levels of endotoxin (A), TNF-α (B), and CRP (C) in subjects with or without T2DM before RYGB and levels in subjects with T2DM at 2 weeks and 12 weeks after surgery. **p<0.01.
Fig. 3
Fig. 3
Pre-surgical microflora. Concentrations of microbes in oral rinses (A, B) and stool (C, D) before RYGB, with subjects stratified as no diabetes/T2DM (A, C) and as HbA1c < 6.5%/HbA1c > 6.5% (B, D).
Fig. 4
Fig. 4
Bifidobacteria. Effect of RYGB on oral Bifidobacteria of subjects without diabetes (A) or with T2DM and HBA1c > 6.5% (B).
See this image and copyright information in PMC

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