Validity and reliability of test strips for the measurement of salivary nitrite concentration with and without the use of mouthwash in healthy adults.

Abstract

The nitrate (NO3-)-nitrite (NO2-)-nitric oxide (NO) pathway has received considerable interest in recent years as a potential target for nutritional interventions designed to increase NO production, and elicit therapeutic effects in humans. In particular, studies have evaluated the effects of supplemental dietary NO3-, which serves as a substrate for this pathway, on numerous different health outcomes. One challenge has been to evaluate compliance with the NO3- interventions. A recent advance in this field has been the development of a non-invasive, simple and rapid method to measure nitrite concentrations in saliva using small test salivary strips. In the present study, ten healthy adults were recruited to a randomised, crossover study and received an acute dose of NO3--rich beetroot juice (BJ) after rinsing their mouth with either water or commercially available antibacterial mouthwash. Salivary NO3- and NO2- concentrations were measured at baseline and up to 5\u202fh after BJ consumption using the gold-standard chemiluminescence and a colorimetric Griess assay. In addition, two salivary test strips (Berkeley Test strips, CA, USA) were used to measure NO2-concentrations at the same time points. Five observers read the strips and inter- and intra-observer reliability was measured. The Bland-Altman method was used to provide a visual representation of the agreement between the methods used to evaluate salivary NO3-/NO2-concentration. Sialin concentrations were measured at baseline and up to 5\u202fh after BJ consumption. BJ elevated salivary NO3- and NO2- concentrations when the mouth was rinsed with water (both P\u202f<\u202f0.01), as assessed via both chemiluminescence and Griess methods. Rinsing the mouth with antibacterial mouthwash attenuated markedly the increase in NO2- (P\u202f<\u202f0.001), while NO3-concentrations were unaffected (P\u202f>\u202f0.05). The Intra-Class Coefficients of Correlation (ICC) showed a high inter- and intra-observer reliability (r\u202f>\u202f0.8). A significant positive correlation was found between absolute salivary NO2- concentrations measured by strips and Griess and chemiluminescence methods (rho\u202f=\u202f0.83 and 0.77, respectively) and also when expressed as changes in salivary NO2- concentrations (rho\u202f=\u202f0.80 and 0.79, respectively). Bland Altman analysis indicated a poor agreement for absolute NO2- concentrations between salivary strips and the chemiluminescence and Griess methods. A small significant negative correlation was found between changes in salivary sialin and salivary NO2- concentrations (r\u202f=\u202f-0.20, P\u202f=\u202f0.04). A non-significant positive correlation was observed between the change in salivary sialin and salivary NO3- concentrations (r\u202f=\u202f0.18, P\u202f=\u202f0.06). This study suggests that commercially available salivary NO2- test strips provide a reasonable surrogate marker for monitoring changes in salivary NO2- concentrations in humans. However, the strips do not provide accurate estimates of absolute NO2- concentrations.