Sheiham Aubrey, James W Philip T
1Department of Epidemiology & Public Health,University College London,1-19 Torrington Place,London WC1E 6BT,UK.
2London School of Hygiene and Tropical Medicine,London,UK,and World Obesity,London,UK.
Public Health Nutr. 2014 Oct;17(10):2176-84. doi: 10.1017/S136898001400113X. Epub 2014 Jun 3.
To examine the quantitative relationship between sugar intake and the progressive development of dental caries.
A critical in-depth review of international studies was conducted. Methods included reassessing relevant studies from the most recent systematic review on the relationship between levels of sugars and dental caries. Reanalysis of dose-response relationships between dietary sugars and caries incidence in teeth with different levels of caries susceptibility in children was done using data from Japanese studies conducted by Takeuchi and co-workers.
Global, with emphasis on marked differences in both national sugar intake and fluoride use and preferably where one factor such as sugar intake changed progressively without changes in other factors over a decade or more.
Children aged 6 years or more and adults.
Caries occurred in both resistant and susceptible teeth of children when sugar intakes were only 2-3 % of energy intake, provided that the teeth had been exposed to sugars for >3 years. Despite increased enamel resistance after tooth eruption, there was a progressive linear increase in caries throughout life, explaining the higher rates of caries in adults than in children. Fluoride affects progression of caries development but there still is a pandemic prevalence of caries in populations worldwide.
Previous analyses based on children have misled public health analyses on sugars. The recommendation that sugar intakes should be ≤10 % of energy intake is no longer acceptable. The much greater adult burden of dental caries highlights the need for very low sugar intakes throughout life, e.g. 2-3 % of energy intake, whether or not fluoride intake is optimum.
研究糖摄入量与龋齿进展之间的定量关系。
对国际研究进行了深入的批判性综述。方法包括重新评估关于糖水平与龋齿关系的最新系统综述中的相关研究。利用竹内及其同事进行的日本研究数据，重新分析了儿童中不同龋齿易感性水平的牙齿中膳食糖与龋齿发病率之间的剂量反应关系。
全球范围，重点关注各国糖摄入量和氟化物使用的显著差异，最好是在十年或更长时间内，糖摄入量等一个因素逐渐变化而其他因素不变的情况。
6岁及以上儿童和成年人。
当糖摄入量仅占能量摄入的2 - 3%时，儿童的抗龋和易感牙齿都会发生龋齿，前提是牙齿接触糖的时间超过3年。尽管牙齿萌出后釉质抵抗力增强，但一生中龋齿仍呈逐渐线性增加，这解释了成年人龋齿发病率高于儿童的原因。氟化物会影响龋齿的发展进程，但全球人群中龋齿仍普遍流行。
以往基于儿童的分析误导了关于糖的公共卫生分析。糖摄入量应≤能量摄入10%的建议已不再可接受。成年人龋齿负担更重突出了一生中极低糖摄入量的必要性，例如占能量摄入的2 - 3%，无论氟摄入量是否最佳。
