Early childhood caries and its associations with sugar consumption, overweight and exclusive breastfeeding in low, middle and high-income countries: an ecological study

Abstract

Aim This ecological study examined the associations between the prevalence of early childhood caries (ECC), overweight, country’s per capita sugar consumption and duration of exclusive breastfeeding. Methods Per capita consumption of sugar in kilograms, percentage of children exclusively breastfed until 6 months of age, percentage of 0–5-year-old children with overweight status, and percentage of 3–5-year-old children with ECC were compared among low-income countries (LICs), middle-income countries (MICs) and high-income countries (HICs). The association between the prevalence of ECC and the study variables, and the effect modification by income region were assessed using multivariable linear regression models. Regression coefficients, confidence intervals, partial eta squared and P-values for effect modification were calculated. Results The per capita sugar consumption in LICs was significantly lower than in MICs (P = 0.001) and HICs (P < 0.001). The percentage of infants who exclusively breastfed up to 6 months was significantly lower in HICs than in LICs (P < 0.001) and MICs (P = 0.003). The prevalence of overweight was significantly lower in LICs than in MICs (P < 0.001) and HICs (P = 0.021). The prevalence of ECC was significantly lower in HICs than in MICs (P < 0.001). Income was a significant modifier of the associations between the prevalence of ECC, per capita sugar consumption (P = 0.005), and exclusive breastfeeding up to 6 months (P = 0.03). The associations between the prevalence of ECC and per capita sugar consumption at the global level and for MICs were stronger (partial eta squared = 0.05 and 0.13 respectively) than for LICs and HICs (partial eta squared <0.0001 and 0.003 respectively). Only in MICs was there a significant association between the prevalence of ECC and per capita sugar consumption (P = 0.002), and between the prevalence of ECC and the percentage of children exclusively breastfed up to 6 months (P = 0.02). Conclusion Though the quantity of sugar consumption and exclusive breastfeeding may be a significant risk indicator for ECC in MICs, sugar consumption may be more of a risk indicator for ECC in HICs than in LICs, and vice versa for exclusive breastfeeding. Although ECC and overweight are both sugar-related diseases, we found no significant relationship between them.

Replication of GWAS significant loci in a sub-Saharan African Cohort with early childhood caries: a pilot study

“…These findings corroborated previous similar studies carried out among Nigerian children [5][6][7][8]. A recent study reported that despite the lower consumption of sugar among children from low-income countries, the prevalence of ECC was high, this could possibly be explained by the impact of the frequency of consumption when compared to the quantity of consumption of sugar [31]. Also, there is access to cheaper high sugar containing meals in low-resourced settings which is a readily accessible alternative diet [32].…”

The Burden of Early Childhood Caries in Children under 5 Years Old in the European Union and Associated Risk Factors: An Ecological Study

“…According to the growing body of literature, the increasing ECC rate is associated with higher sugar intake [ 44 ]. In a worldwide ecological study, the per capita added sugar consumption in low-, middle-, and high-income countries was assessed.…”

“…The added sugar consumption in low-income countries was found to be significantly lower than in middle- and high-income countries. However, this study found a correlation between the prevalence of ECC and sugar consumption only in middle-income countries [ 44 ]. The multivariate analysis revealed that the contribution of sugar consumption at population level has a significant impact on YLD, which suggests that YLD could be improved by lowering sugar consumption.…”

“…It also emphasized that there is a general association between a carbohydrate-based diet and socioeconomic factors; thus, the link between caries and socioeconomic factors, including education level, is very complex. The dose–response relationship between sugar consumption and ECC may explain the increasing ECC burden [ 44 , 47 ], primarily in less-privileged societies of the EU [ 48 ], and there is also a significant association with education level. Children of less educated mothers tend to consume more sugar in their diet, or be exposed to poor nutrition, and are less likely to visit the dentist [ 25 , 49 , 50 , 51 , 52 ].…”

“…Children of less educated mothers tend to consume more sugar in their diet, or be exposed to poor nutrition, and are less likely to visit the dentist [ 25 , 49 , 50 , 51 , 52 ]. The role of sugar consumption may also overwhelm preventive measures of routine dental checkups or other preventive factors [ 44 ].…”