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Abstract
The global “nutrition transition” has increased children’s consumption of sugary snacks and beverages (junk food), compounding their risk for poor oral health and malnutrition. The purpose of this study was to examine the relationship between early childhood caries (ECC) and malnutrition in a community context. This is a baseline and two-year follow-up analysis of a community-based preventive oral health and nutrition intervention for 1,575 children, from birth through age six, in an indigenous population in rural Ecuador. Trained community volunteers, preschool teachers and dentists provided children and families with nutrition and oral health education, toothbrushes and fluoride toothpaste, fluoride varnish, and referral for dental treatment, three times per year. Annual data collection included mother interviews, child dental examinations and measurements of height and weight. Descriptive and bivariate analyses were completed in SPSS. At baseline, nearly half of children consumed junk food daily. ECC began in infancy, increasing steadily thereafter. Among one-year-olds, 53.8% had caries with a mean of 2.1 decayed teeth; and among six-year-olds, 98.6% had caries with a mean of 10.5 decayed teeth, and half experienced mouth pain. At two-year follow-up, reported junk food consumption was cut in half; and the prevalence and severity of caries and mouth pain were reduced. Children who entered the intervention in their first year of life experienced the greatest dental improvements. Children who entered in their first two years and attended the entire two-year intervention experienced a one-third reduction in stunting malnutrition, with greatest improvement among those whose caries increment was controlled. ECC and caries-related malnutrition were reduced for children who participated in this prevention-oriented community oral health and nutrition intervention, especially those beginning in the first two years of life. Oral health and nutrition promotion should be incorporated into all maternal-child health programs, from pregnancy and birth onward.
Highlights
The global “nutrition transition” has increased children’s consumption of sugary snacks and beverages, compounding their risk for poor oral health and malnutrition
The global “nutrition transition”—a shift from the traditional diet to the modern diet—has contributed to a “double burden” of under-malnutrition and overweight/obesity in low- and middle-income countries [2, 3]
While early childhood caries (ECC) is caused by a combination of an oral bacterial biofilm, the diet, and factors relating to the host such as tooth morphology or medical conditions [5], dietary sugars are considered the primary drivers of the progression of dental caries [6]
Summary
The global “nutrition transition” has increased children’s consumption of sugary snacks and beverages (junk food), compounding their risk for poor oral health and malnutrition. The global “nutrition transition”—a shift from the traditional diet (breastfeeding, agriculturalbased foods, regular meals) to the modern diet (bottlefeeding, processed sugary and non-nutritious foods/ drinks, frequent snacking)—has contributed to a “double burden” of under-malnutrition and overweight/obesity in low- and middle-income countries [2, 3]. Another consequence of the nutrition transition is the global pandemic of early childhood caries (ECC), or tooth decay, currently the most common chronic disease of childhood, affecting 60–90% of children worldwide [4]. Due to low political prioritization of oral health, most children have poor access to dental care, leaving most caries untreated, commonly leading to bacterial invasion of the pulp and tooth-supporting structures, chronic infection and mouth pain [9]
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