Oral Health Outcomes of Early Childhood Malnutrition

描述(申请人提供)：这项回顾性队列研究的主要目标是评估早期蛋白质-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)釉质发育不良，3)牙齿萌出时间，4)唾液功能。拟议的调查将寻求评估儿童早期PEM(年龄出生-5岁)和12-18岁这些口腔结果之间的明确剂量-反应和时间关系。牙釉质发育不良、唾液腺功能低下、牙齿萌出时间以及社会和行为危险因素作为PEM暴露后龋齿的可能机制的解释模型将被检验。现有的少数已发表的关于PEM和口腔结局的人体研究通常是横断面设计，对混淆变量的控制有限，而且几乎完全集中在乳牙列上。到目前为止，还没有关于过去PEM暴露的高质量数据库，这些数据库有10年或更长的滞后期，可以研究儿童早期营养不良对恒牙的影响。这项研究将利用海地发生的一种“自然实验情况”，即一个关于儿童在其生命的头5年经历了全方位PEM的连续称重的数据库，并将最大限度地延长自暴露以来用于疾病确定的时间。将使用海地健康基金会自1988年以来对16000多名儿童维护的持续数据库中的权重来评估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组儿童的口腔健康数据，根据他们接触PEM的严重程度和慢性程度按营养状况分层。将从每个PEM阶层中随机招募年龄和性别相匹配的12-18岁儿童作为随机样本，总样本为1,250名儿童。调查将包括由美国和海地训练有素的牙医和流行病学家组成的经过校准的团队进行的为期四个月的现场牙科检查、唾液采集和访谈调查。初步分析将由回归模型组成，该模型将评估四种口服结果与PEM水平和社会/行为因素之间的关系，以及确定特定年龄的临界PEM暴露(S)。这项研究的结果将提供第一个关于儿童早期PEM对完整恒牙列的潜在影响的科学证据，这是基于一项回溯性纵向队列研究。鉴于PEM病理生理学的普遍性，这项研究的发现将适用于具有口腔健康差异的美国儿童亚类。

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 12-18 years. An explanatory model of enamel hypoplasia, salivary gland hypofunction, tooth eruption timing, and social and behavioral 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 12-18 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 social/behavioral 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 oral health disparities.