Dental caries and beverage consumption in young children
Dental caries and beverage consumption in young children
复制标题
DOI：
10.1542/peds.112.3.e184
复制
发表时间：
2003-09-01
期刊：
影响因子：
8
通讯作者：
Stumbo, PJ
中科院分区：
文献类型：
--
作者：
Marshall, TA;Levy, SM;Stumbo, PJ
Objective.龋齿是儿童常见的慢性疾病。当代饮料模式的变化，特别是减少牛奶摄入量和增加100%果汁和汽水摄入量，对幼儿龋齿的影响尚不清楚。我们描述了幼儿的龋齿经历和乳制品、含糖饮料、营养素和整体饮食质量的摄入之间的关联。受试者（n = 642）是爱荷华州氟化物研究的成员，该研究是一项从出生起进行随访的队列研究。食物和营养素摄入量来自1岁（n = 636）、2岁（n = 525）、3岁（n = 441）、4岁（n = 410）和5岁（n = 417）时分析的3天饮食记录，并累积1至5岁（n = 396）。膳食质量由营养充足率（NARs）定义，并计算为营养素摄入量与推荐膳食摄入量/充足摄入量的比值。在4至7岁时，由2名经过培训和校准的牙医在牙科检查期间确定龋齿。检查是目视检查，但使用牙科探查器确认可疑结果。龋齿的经验进行了评估，在牙齿和表面水平。使用SAS分析数据。Wilcoxon秩和检验用于比较有和无龋齿经历的受试者的食物摄入量、营养素摄入量和NAR。Logistic和Tobit回归分析用于确定饮食变量和龋齿经验之间的关联，并建立模型来预测龋齿经验。并非所有的食物摄入量和NARs和龋齿经验之间的关系是线性的，因此，分类变量被用来开发模型来预测龋齿的经验。食物和饮料的摄入分为无、低和高摄入，NARs分为不足、低充足和高充足。有龋齿的受试者在2岁和3岁时的牛奶摄入量中位数低于无龋齿的受试者。与无龋齿的受试者相比，有龋齿的受试者在2、3、4和5年以及1至5年的常规（含糖）汽水的中位摄入量较高;在1、4和5年以及1至5年的常规粉末饮料;以及在4和5年的总含糖饮料。Logistic回归模型开发的暴露变量在1，2，3，4，5年和1至5年，以预测任何龋齿的经验，在4至7岁。在所有年龄的模型中保留牙科检查时的年龄。0摄入量（与低和高摄入量相比）的儿童在1岁时从粉末中摄取常规饮料，在2和3岁时摄取常规苏打汽水，在5岁时从粉末中摄取无糖饮料，患龋齿的风险降低。与不摄入或低摄入的受试者相比，在4年和5年以及1年至5年期间高摄入常规粉末饮料以及在5年和1年至5年期间高摄入常规苏打汽水与龋齿经历的几率显著增加相关。5年时100%果汁的低摄入量（与无或高摄入量相比）与龋齿经验减少有关。一般而言，营养素（如核黄素、铜、维生素D、维生素B-12）摄入不足（相对于摄入不足或摄入过量）与龋齿发生率增加相关，营养素（如维生素B12、维生素C）摄入不足（相对于摄入不足或摄入过量）与龋齿发生率降低相关。一个例外是维生素E，无论是低或高足够的摄入量与增加龋齿的经验，在不同的年龄。多变量Tobit回归模型被开发为1至5年的暴露变量，以预测在4至7岁的龋齿经验的牙齿表面的数量。年龄在牙科检查显示出显着的正相关性和氟暴露显示出显着的负相关性与最终模型中的龋齿经验的牙齿表面的数量。低摄入量的非牛奶乳制品食品（与高摄入量;所有受试者都有一些非牛奶乳制品摄入量）和高充足的维生素C摄入量（与不足和低充足的摄入量）与较少的牙齿表面有龋齿的经验。高摄入量的普通苏打汽水（与无和低摄入量）与更多的牙齿表面有龋齿的经验。我们的研究结果表明，当代饮料模式的变化，特别是汽水消费的增加，有可能增加儿童的龋齿率。经常饮用苏打汽水，经常饮用粉末饮料，以及在较小程度上饮用100%果汁与龋齿风险增加有关。牛奶与龋齿呈中性相关。不同类型的含糖饮料和龋齿经验之间的关联并不相等，这可能是由于饮料的糖成分不同或在饮食中的作用不同。我们的数据支持当代儿童饮食指南：每天食用2份或更多的乳制品，每天限制100%果汁的摄入量为4至6盎司，并限制偶尔使用其他含糖饮料。儿科医生，儿科护士执业者和营养师能够支持儿科牙医为幼儿的父母提供预防指导。
Objective. Dental caries is a common, chronic disease of childhood. The impact of contemporary changes in beverage patterns, specifically decreased milk intakes and increased 100% juice and soda pop intakes, on dental caries in young children is unknown. We describe associations among caries experience and intakes of dairy foods, sugared beverages, and nutrients and overall diet quality in young children.Methods. Subjects (n = 642) are members of the Iowa Fluoride Study, a cohort followed from birth. Food and nutrient intakes were obtained from 3-day diet records analyzed at 1 ( n = 636), 2 ( n = 525), 3 ( n = 441), 4 ( n = 410), and 5 ( n = 417) years and cumulatively for 1 through 5 ( n = 396) years of age. Diet quality was defined by nutrient adequacy ratios (NARs) and calculated as the ratio of nutrient intake to Recommended Dietary Allowance/ Adequate Intake. Caries were identified during dental examinations by 2 trained and calibrated dentists at 4 to 7 years of age. Examinations were visual, but a dental explorer was used to confirm questionable findings. Caries experience was assessed at both the tooth and the surface levels. Data were analyzed using SAS. The Wilcoxon rank sum test was used to compare food intakes, nutrient intakes, and NARs of subjects with and without caries experience. Logistic and Tobit regression analyses were used to identify associations among diet variables and caries experience and to develop models to predict caries experience. Not all relationships between food intakes and NARs and caries experience were linear; therefore, categorical variables were used to develop models to predict caries experience. Food and beverage intakes were categorized as none, low, and high intakes, and NARs were categorized as inadequate, low adequate, and high adequate.Results. Subjects with caries had lower median intakes of milk at 2 and 3 years of age than subjects without caries. Subjects with caries had higher median intakes of regular ( sugared) soda pop at 2, 3, 4, and 5 years and for 1 through 5 years; regular beverages from powder at 1, 4, and 5 years and for 1 through 5 years; and total sugared beverages at 4 and 5 years than subjects without caries. Logistic regression models were developed for exposure variables at 1, 2, 3, 4, and 5 years and for 1 through 5 years to predict any caries experience at 4 to 7 years of age. Age at dental examination was retained in models at all ages. Children with 0 intake ( vs low and high intakes) of regular beverages from powder at 1 year, regular soda pop at 2 and 3 years, and sugar-free beverages from powder at 5 years had a decreased risk of caries experience. High intakes of regular beverages from powder at 4 and 5 years and for 1 through 5 years and regular soda pop at 5 years and for 1 through 5 years were associated with significantly increased odds of caries experience relative to subjects with none or low intakes. Low ( vs none or high) intakes of 100% juice at 5 years were associated with decreased caries experience. In general, inadequate intakes ( vs low adequate or high adequate intakes) of nutrients (eg, riboflavin, copper, vitamin D, vitamin B-12) were associated with increased caries experience and low adequate intakes ( vs inadequate or high adequate intakes) of nutrients ( eg, vitamin B12, vitamin C) were associated with decreased caries experience. An exception was vitamin E; either low or high adequate intakes were associated with increased caries experience at various ages. Multivariable Tobit regression models were developed for 1- through 5-year exposure variables to predict the number of tooth surfaces with caries experience at 4 to 7 years of age. Age at dental examination showed a significant positive association and fluoride exposure showed a significant negative association with the number of tooth surfaces with caries experience in the final model. Low intakes of nonmilk dairy foods ( vs high intakes; all subjects had some nonmilk dairy intakes) and high adequate intakes of vitamin C ( vs inadequate and low adequate intakes) were associated with fewer tooth surfaces having caries experience. High intakes of regular soda pop ( vs none and low intakes) were associated with more tooth surfaces having caries experience.Conclusions. Results of our study suggest that contemporary changes in beverage patterns, particularly the increase in soda pop consumption, have the potential to increase dental caries rates in children. Consumption of regular soda pop, regular powdered beverages, and, to a lesser extent, 100% juice was associated with increased caries risk. Milk had a neutral association with caries. Associations between different types of sugared beverages and caries experience were not equivalent, which could be attributable to the different sugar compositions of the beverages or different roles in the diet. Our data support contemporary dietary guidelines for children: consume 2 or more servings of dairy foods daily, limit intake of 100% juice to 4 to 6 oz daily, and restrict other sugared beverages to occasional use. Pediatricians, pediatric nurse practitioners, and dietitians are in a position to support pediatric dentists in providing preventive guidance to parents of young children.