Maternal Nutrition Education and Early Childhood Caries: A Randomized Field Trial

描述（由申请人提供）：幼儿龋齿，主要导致幼儿蛀牙的疾病过程，是世界范围内非常常见的疾病。除了作为疼痛和感染的来源之外，龋齿还可能影响儿童的饮食，睡眠和在学校集中注意力的能力。营养，沿着婴儿和幼儿喂养实践，如过度吃零食和使用奶瓶，在龋齿的发展中起着重要作用，因此，努力改善营养和喂养行为可能会产生口腔健康的好处，超过一般健康的改善。在巴西这样的国家，同时面临着持续营养不足和日益超重的人口的公共卫生挑战，从生命一开始就改善喂养方法的孕产妇营养咨询可能会特别有影响力。考虑到这一点，巴西卫生部制定了一套有针对性的建议：“巴西两岁以下儿童健康喂养的十个步骤。虽然先前的证据表明，“十步”建议可以有效地改善口腔和整体健康结果时，纳入一个密集的家庭干预计划，家访并不代表一个负担得起的公共卫生选择大规模。目前尚不清楚，作为替代方案，使用现有的公共卫生基础设施来提供这些营养教育信息，是否同样适合有效预防龋齿。为了回答这一问题，2008年开始，巴西波尔图阿莱格雷市的20个公共初级卫生保健服务点参加了一项随机对照田间试验。在大约一半的地点，保健服务提供者接受了培训，以便在例行产前和儿科就诊期间向母亲提供十步方案中概述的营养教育。对于那些在对照组中的站点工作的服务提供者，没有干扰通常的做法。本项目将评估该计划的有效性，医疗保健提供者培训的十个步骤的建议，以改善学龄前儿童的口腔健康结果。预计与对照组中母亲参加医疗保健服务的儿童相比，那些访问提供母亲营养教育的网站的儿童不太可能经历蛀牙或严重蛀牙，不太可能超出身高和体重的正常生长标准，并将表现出改善的饮食，包括更少的高糖和高脂肪食物，以及其他健康益处。如果这一计划被证明是有效的，它可以作为未来公共卫生政策在各种环境中的模式。即使两组之间没有观察到实质性差异，这项研究也将有助于确定与口腔健康和其他健康结果最密切相关的个体喂养行为。这些信息直接适用于制定负担得起的、有针对性的战略，以更好地预防各种环境中的幼儿龋齿。

DESCRIPTION (provided by applicant): Early childhood dental caries, the disease process primarily responsible for tooth decay among young children, is an extremely common condition worldwide. Beyond its role as a source of pain and infection, dental caries may impact a child's ability to eat, sleep, and concentrate in school. Nutrition, along with infant and toddler feeding practices such excessive snacking and bottle use, plays an import role in the development of dental caries, and thus, efforts to improve nutrition and feeding behavior may yield oral health benefits above and beyond improvements in general health. In a country such as Brazil, which simultaneously faces public health challenges from both persistent under nutrition and an increasingly overweight population, maternal nutrition counseling to improve feeding practices from the very start of life may prove particularly impactful. With this in mind, the Brazilian Ministry of Health developed a set of targeted recommendations: the "Ten Steps of Healthy Feeding for Brazilian Children Under Two Years of Age." While prior evidence suggests that the "Ten Steps" recommendations can effectively improve oral and overall health outcomes when incorporated into an intensive home intervention program, home visits do not represent an affordable public health option on a large scale. It is not known whether as an alternative, using the existing public health infrastructure for delivery of these nutrition education messages, is similarly well suited for effective caries prevention. Aiming to answer this question, twenty public primary healthcare service sites in the city of Porto Alegre, Brazil were enrolled in a randomized controlled field trial beginning in 2008. At about half the sites, health service providers were trained to provide the nutrition education outlined in the Ten Steps program to mothers during routine prenatal and pediatric visits. For those service providers working at sites in the control group, there was no interference with usual practices. This project will evaluate the effectiveness of this program of healthcare provider training in the Ten Steps recommendations to improve oral health outcomes in preschool age children. It is expected that compared to children whose mothers attended healthcare service sites in the control group, those visiting sites delivering maternal nutrition education will be less likely to have experienced tooth decay or severe tooth decay, will be less likely to fall outside the normal growth standards for height and weight, and will demonstrate an improved diet consisting of fewer high-sugar and high-fat foods, among other health benefits. Should this program prove effective, it could serve as a model for future public health policy in a variety of settings. Even should substantial differences not be observed across the two groups, this study will help to identify the individual feeding behaviors most strongly associated with oral health and other health outcomes. Such information is directly applicable to the development of affordable, targeted strategies for better prevention of early childhood dental caries in a variety of settings.