Oral Health Outcomes of Early Childhood Malnutrition

描述（由申请人提供）：本回顾性队列研究的主要目的是评估早期蛋白质能量营养不良（PEM）对恒牙列的影响，特别是在以下方面：1)龋齿，2)牙釉质发育不全，3)牙齿出牙时间，4)唾液功能。拟议的调查将寻求评估早期儿童PEM（出生-5岁）与10-18岁这些口腔结局之间明确的剂量-反应和时间关系。一个解释模型，釉质发育不全，唾液腺功能减退，牙齿出牙时间，以及社会经济风险因素作为PEM暴露后龋齿的可能机制将被检查。现有发表的少数关于PEM和口腔结果的人类研究通常是横断面设计，对混杂变量的控制有限，并且几乎完全集中在初级牙列上。到目前为止，还没有高质量的过去PEM暴露的数据库，并没有足够的滞后10年或更长时间来研究儿童早期营养不良对恒牙列的影响。这项研究将利用在海地发生的一种“自然实验情况”，即建立一个5岁前儿童的连续加权数据库，这些儿童经历了各种各样的PEM，并将最大限度地延长接触后确定疾病的时间。将使用海地卫生基金会自1988年以来一直维持的数据库中对16 000多名儿童的体重评估PEM暴露情况。完成这一自然实验只需要从这16 000名儿童中随机选择一个亚组，根据他们接触PEM的严重程度和慢性程度，按营养状况分层，收集口腔健康数据。将从每个PEM阶层中随机抽取年龄和性别相匹配的10-18岁儿童样本，共计1,250名儿童。调查将包括为期4个月的实地牙科检查、唾液收集和访谈调查，由经过校准的美国和海地培训的牙医和流行病学家组成。主要分析将包括回归模型，该模型将评估四种口服结果与PEM水平和社会经济因素之间的关系，以及确定年龄特异性关键PEM暴露。本研究的发现将基于一项回顾性纵向队列研究，为儿童早期PEM对完整恒牙列的潜在影响提供第一个科学证据。鉴于PEM病理生理学的普遍性，本研究的结果将推广到具有9种口腔健康差异的美国儿童亚群。

DESCRIPTION (provided by applicant): The primary objectives of this retrospective cohort study are to assess the impact of early protein-energy malnutrition (PEM) on the permanent dentition, specifically with respect to: 1) dental caries, 2) enamel hypoplasia, 3) tooth eruption timing, and 4) salivary function. The proposed investigation will seek to assess clear dose-response and temporal relationships between early childhood PEM (ages birth-5 years old) and these oral outcomes at ages 10-18 years. An explanatory model of enamel hypoplasia, salivary gland hypofunction, tooth eruption timing, and socioeconomic risk factors as possible mechanisms for caries following PEM exposure will be examined. The few existing published human studies of PEM and oral outcomes were typically of cross-sectional design, with limited control for confounding variables, and almost exclusively focused on the primary dentition. Until now, there has been no high quality data base of past PEM exposure with a sufficient lag period of 10 years or more to allow the study of early childhood malnutrition effects on the permanent dentition. This study will capitalize on a 'natural experiment situation' that has occurred in Haiti, i.e. a database of serial weightings of children in their first 5 years of life, who had experienced the full range of PEM, and will maximize the time since exposure for disease determination. PEM exposure will be assessed using weights included in an ongoing Haitian Health Foundation database maintained since 1988 on over 16,000 children. The completion of this natural experiment only requires the collection of the oral health data from a randomly selected sub-group of these 16,000 children, stratified by nutrition status according to the severity and chronicity of their exposure to PEM. A random sample of 10-18 year old children frequency matched for age and gender will be recruited from each PEM stratum, for a total sample of 1,250 children. The investigation will consist of a four-month-long field dental examination, saliva collection and interview survey by a calibrated team of U.S. and Haitian trained dentists and epidemiologists. The primary analyses will consist of regression models that will assess the associations between the four oral outcomes and PEM levels and socioeconomic factors, as well as determining age-specific critical PEM exposure(s). The findings of this study will provide the first scientific evidence regarding the potential effect of early childhood PEM on the complete permanent dentition based on a retrospective longitudinal cohort study. Given the universality of PEM pathophysiology, this study's findings will be generalizable to subsets of U.S. children having 9 oral health disparities.