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

描述(申请人提供)：儿童早期龋齿是一种在世界范围内非常常见的疾病，它是导致幼儿龋齿的主要原因。除了作为疼痛和感染源的作用外，龋齿还可能影响儿童的进食、睡眠和在学校集中注意力的能力。营养，以及婴儿和幼儿的喂养习惯，如过量吃零食和使用奶瓶，在龋齿的发展中发挥着重要作用，因此，努力改善营养和喂养行为可能会产生比改善一般健康更多的口腔健康益处。在像巴西这样的国家，同时面临持续营养不良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习惯的产妇营养咨询可能被证明特别有影响力。有鉴于此，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十步》。虽然先前的证据表明，当纳入密集的家庭干预计划时，“十步”建议可以有效地改善口腔和整体健康结果，但家访并不代表大规模的负担得起的公共卫生选择。目前尚不清楚，作为一种替代方案，利用现有的公共卫生基础设施来传递这些营养教育信息，是否同样非常适合有效地预防龋齿。为了回答这个问题，从2008年开始，巴西阿雷格里港的20个公共初级卫生保健服务点参加了一项随机对照现场试验。在大约一半的地点，卫生服务提供者接受了培训，以便在常规产前和儿科访问期间向母亲提供十步计划中概述的营养教育。对于在控制组中的地点工作的服务提供者来说，没有干扰通常的做法。该项目将评估这一医疗保健提供者培训计划的有效性，即十步建议，以改善学龄前儿童的口腔健康结果。预计与母亲在对照组医疗服务网站就诊的孩子相比，那些访问母亲营养教育网站的孩子不太可能经历龋齿或严重龋齿，不太可能超出正常的身高和体重增长标准，并将展示由更少的高糖和高脂肪食物组成的改善饮食，以及其他健康益处。如果这一计划被证明是有效的，它可以作为未来各种环境下公共卫生政策的典范。即使在两组中没有观察到实质性的差异，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，以便在各种环境中更好地预防儿童早期龋齿。 公共卫生相关性：预防儿童早期龋齿的成功干预措施必须是有效的，相对容易地提供，并在生命足够早的时候有针对性，以便在疾病发病之前。该项目测试了一种文化上适当的、基于证据的母亲营养和喂养教育计划改善学龄前儿童口腔健康结果的能力。如果有效，这项计划可能会成为大规模公共卫生政策的典范，旨在不仅减少儿童龋齿，还改善儿童营养。

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. PUBLIC HEALTH RELEVANCE: Successful interventions to prevent early childhood dental caries must be effective, delivered with relative ease, and targeted early enough in life to precede disease onset. This project tests the ability of a culturally appropriate, evidence-based maternal nutrition and feeding education program to improve oral health outcomes among preschool children. If effective, this program may serve as a model for large-scale public health policy aimed at not only reducing childhood dental caries but also improving childhood nutrition.