Excess Body Weight, Snack Limits and Dental Caries in Brazilian Preschoolers: A Population-Based Study

Abstract

Objective: To evaluate the relationship between excess body weight (EBW) and the prevalence of dental caries in preschoolers considering parental control regarding snack consumption. Material and Methods: An observational, population-based, cross-sectional study was conducted at Municipal Child Education Centers in the city of Curitiba, Brazil, involving a representative sample of 686 preschool children aged four to five years and eleven months and their parents/caregivers. Dental caries was analyzed using the dmft index. Weight and height were measured for the determination of the body mass index, which was categorized for each zscore range considering age and sex. Children with overweight or obesity were considered to have EBW. The assessment of nutritional status was performed with the aid of the WHO Anthro and WHO Anthro Plus programs. The data were analyzed using univariate and multivariate Poisson regression analysis with robust variance (α= 0.05). Results: The children with EBW had a lower prevalence rate of caries, but this association lost its significance when adjusted by the other variables included in the multivariate model. In the multivariate regression analysis, household income per capita (PR=0.804; 95%CI: 0.665-0.972), child's age (PR=1.015; 95%CI: 1.001-1.029) and snack limits (PR=0.839; 95%IC: 0.732-0.962) were associated with a greater prevalence rate of dental caries. Conclusion: Excess body weight was not significantly associated with dental caries, whereas a lower parental limit regarding snack consumption by the children was independently associated with a higher prevalence rate of dental caries.

Prevalence of childhood obesity in Brazil: systematic review and meta-analysis

“…1 ). 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 The references of all reports of included studies is listed in the Supplementary Material Appendix 1 and the reason for exclusion of the 222 studies assessed for data extraction is listed in Supplementary Material Appendix 2.

Figure 1 Process of selection and inclusion of studies in the systematic review.

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Overweight/obesity and dental caries in Brazilian children and adolescents: a systematic review and meta-analysis

“…Tw e n t y -t h r e e s t u d i e s t e s t e d t h e association bet ween overweight and dental caries. 12,36,29,30,32,34,35,37,39,43,44,47,48,52,53,[55][56][57][58][59][60][61]66 Of these, 21 found no association between the two variables investigated in children/adolescents. 12,36,29,30,32,34,37,39,[43][44][45]48,[51][52][53][56][57][58][59][60]66 Three studies concluded that overweight children/ adolescents were less likely to exhibit dental caries than their normal weight peers.…”

“…12,36,29,30,32,34,35,37,39,43,44,47,48,52,53,[55][56][57][58][59][60][61]66 Of these, 21 found no association between the two variables investigated in children/adolescents. 12,36,29,30,32,34,37,39,[43][44][45]48,[51][52][53][56][57][58][59][60]66 Three studies concluded that overweight children/ adolescents were less likely to exhibit dental caries than their normal weight peers. 47,55,61 Obesity vs. dental caries Twenty-three studies tested the association between obesity and dental caries.…”

“…Nutritional status was classified based on BMI in all the studies, and the following reference curves were used to define obesity in children: National Center for Health Statistics, 5,46,62 Centers for Disease Control and Prevention (NCHS/CDC), 28,29,34,42,53,63 International Obesity Task Force (IOTF), 41 WHO/20 06, 12,15,30,36,40,46,48,51,54,55,59 WHO/2007, 31,34,35,38,43,44,47,49,51,53,55-57, 60,61,64,66 Hammer et al, criteria, 52 Conde and Monteiro 37 and Cole et al 33 Six studies 28,29,34,42,62,64 assessed child and adolescent overweight and obesity using the BMI for age and gender percentiles from the Centers for Disease Control and Prevention 2000 (CDC 2000) growth charts for children and adolescents from 2 to 20 years old (overweight: ≥ 85 th percentile < 95 th percentile, and obesity: ≥ 95 th percentile), while one paper 52 used similar parameters based on Hammer et al Ten studies used BMI for age and gender according to WHO for children younger than five years old, expressed by percentiles (overweight: ≥ 85 th percentile < 97 th percentile, and obesity: ≥ 97 th percentile) 30,48,51,54,55 or by Z-score (overweight: Z-score > 1, and obesity: Z-score > 2). [14][15][16]40,…”

“…In addition, it can lead to difficulties in the patient's school performance, socialization and self-esteem, and can compromise the daily life of parents or caregivers. 8,[12][13][14][15] Overweight/obesity and dental caries share common risk factors apart from high sugar diet intake, such as lower socioeconomic status (SES), and social-environmental factors, which might explain the association between these two conditions. Moreover, although the scientific literature supports the coexistence of overweight/obesity and dental caries, conflicting results have been described in different populations 7,16 .…”