Freeman Ruth
Oral Health and Health Research Programme, DHSRU, University of Dundee, Dundee, Scotland.
Evid Based Dent. 2014 Dec;15(4):98-9. doi: 10.1038/sj.ebd.6401055.
Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), LILACS (Latin American and Caribbean Health Sciences), CNKI (China National Knowledge Infrastructure), Wanfang (China) and the South African Department of Health databases were searched. In addition the archives at the WHO Collaborating Centre for Nutrition and Oral Health at Newcastle University and reference lists of reviews were searched and experts contacted for further relevant papers.
Intervention, cohort population or cross sectional studies were considered where there was any intervention to alter the intake of sugar or the intake of sugars or change of sugar intake was monitored. The main outcome was caries incidence. The GRADE (Grading of Recommendations Assessment Development and Evaluation) system was used to assess study quality.
Separate data abstraction forms were designed for RCTs and observational studies and meta-analyses were to be conducted where possible.
Sixty-five papers reporting 55 studies were included. No RCTs were identified. Three studies (four papers) were interventional, eight (12 papers) were prospective cohort, 20 (25 papers) were population based and 24 (25 papers) were cross-sectional. Data variability limited meta-analysis. Of the studies, 42 out of 50 of those in children and five out of five in adults reported at least one positive association between sugars and caries.Five of the eight cohort studies allowed comparison of dental caries development when sugars consumption was equivalent to a level < 10% E (Energy) or > 10% E. All eight studies found higher caries with sugars intake > 10% E compared with < 10% E.
This in-depth systematic review shows consistent evidence of moderate quality supporting a relationship between the amount of sugars consumed and dental caries development. There is evidence of moderate quality to show that dental caries is lower when free-sugars intake is < 10% E. Dental caries progresses with age, and the effects of sugars on the dentition are lifelong. Even low levels of caries in childhood are of significance to levels of caries throughout the life course. Analysis of the data suggests that there may be benefit in limiting sugars to < 5% E to minimise the risk of dental caries throughout the life course.
检索了Medline、Embase、Cochrane对照试验中央注册库（CENTRAL）、拉丁美洲和加勒比卫生科学数据库（LILACS）、中国知网（CNKI）、万方数据库（中国）以及南非卫生部数据库。此外，还检索了纽卡斯尔大学世界卫生组织营养与口腔健康合作中心的档案以及综述的参考文献列表，并联系专家获取更多相关论文。
若存在任何改变糖摄入量或监测糖摄入量变化的干预措施，则纳入干预性、队列人群或横断面研究。主要结局为龋齿发病率。采用GRADE（推荐分级评估、制定与评价）系统评估研究质量。
为随机对照试验和观察性研究设计了单独的数据提取表格，并尽可能进行荟萃分析。
纳入了65篇报告55项研究的论文。未检索到随机对照试验。3项研究（4篇论文）为干预性研究，8项（12篇论文）为前瞻性队列研究，20项（25篇论文）为基于人群的研究，24项（25篇论文）为横断面研究。数据变异性限制了荟萃分析。在这些研究中，50项儿童研究中的42项以及5项成人研究中的5项报告糖与龋齿之间至少存在一种正相关。8项队列研究中的5项允许在糖摄入量相当于能量摄入低于10%或高于10%时比较龋齿发展情况。所有8项研究均发现，与糖摄入量低于10%相比，糖摄入量高于10%时龋齿发生率更高。
这项深入的系统评价显示，有中等质量的一致证据支持糖摄入量与龋齿发展之间的关系。有中等质量的证据表明，当游离糖摄入量低于能量摄入的10%时，龋齿发生率较低。龋齿随年龄增长而进展，糖对牙列的影响是终身的。即使儿童期龋齿水平较低，对一生的龋齿水平也具有重要意义。数据分析表明，将糖摄入量限制在能量摄入的5%以下可能有助于将一生患龋齿的风险降至最低。
