Résumé
- Objectives and studyIn the neonatal period, some severe digestive diseases require the cessation of oral feeding and the use of enteral or parenteral nutrition for prolonged periods. In some cases, this by-pass of the oral cavity during the early stages of feeding results in the development of so-called oral disorders (OD). Oral disorders may persist for years after healing of the causal disease, and are expressed for example by an exacerbated gag reflex, difficulties in chewing and swallowing and high food selectivity.The aim of this study were to describe the consequences on oral physiology of oral by-pass and enteral nutrition in a population of 21 children who suffered oral disorder (OD) compared to a healthy control population (NOD, n=23). - MethodsThe two populations were followed during one year with three saplings and compared regarding 1) their food sensitivity (consisting to measured feeding difficulties, food preferences and food habits with a questionnaire approach); and 2) their salivary composition .Proteome analyses were performed with different methods. First, spots of interest on 2D gel electrophoresis were manually excised and after tryptic digestion, MALDI-TOF/TOF acquisitions lead to identifications. SELDI-TOF MS profiling with ProteinChips arrays was also carried out.Peptidome profiling by label-free MALDI-TOF allows to detect potential markers, identification of discriminant peaks was attempted by MALDI-TOF-TOF and nanoLC-ESI MS-MS.Metabolome analyses were performed by 1H NMR. Following statistical analysis, discriminant buckets were assigned to metabolites using reference spectra from reference databases.- ResultsWe included 21 children who suffered oral disorder (OD) and 23 age- and sex-matched healthy controls 1) On feeding difficulty aspects, OD children were separated significantly on 6 dimensions reflecting eating difficulties (oral tactile sensitivity, appetite and interest for food, sensitivity to food texture, sensitivity to the tastes, sensitivity to temperature). Moreover, consumption frequency, number of consumed foods and liking were lower for the OD compared to the controls children for specific food groups.2) On salivary composition, despite heterogeneity within the groups (age, pathology, medication, etc.), the three spectral methods (MALDI-TOF, SELDI-TOF, 1H NMR) allowed discriminating OD and controls, confirming that oral stimulation by food intake plays a role in shaping the composition of saliva. Saliva of OD patients exhibited a lower antioxidant status and lower levels of the salivary protease inhibitors cystatins. Other discriminant features (IgA1, dimethylamine) may relate to modified oral and/or intestinal microbial ecology. Finally, salivary profiles of OD patients were partly comparable to those of subjects with exacerbated gustatory sensitivities, in particular with reduced abundance of cystatin SN and higher abundance of zinc-alpha-glycoprotein. - ConclusionDespite heterogeneity within the groups in terms of age/developmental stage and initial pathology in the patients group, feeding preferences such as salivary profiles specifically associated to oral disorders were identified. Whether this translates taste hypersensitivity and contributes to the eating difficulties deserves further attention.