Smithers Lisa G, Lynch John, Hedges Joanne, Jamieson Lisa M
1School of Public Health,University of Adelaide,Adelaide,SA 5005,Australia.
3Indigenous Oral Health Unit,Australian Centre for Population Oral Health,University of Adelaide,Adelaide, SA 5005,Australia.
Br J Nutr. 2017 Dec;118(12):1061-1069. doi: 10.1017/S000711451700318X. Epub 2017 Dec 4.
There are marked disparities between indigenous and non-indigenous children's diets and oral health. Both diet and oral health are linked to longer-term health problems. We aimed to investigate whether a culturally appropriate multi-faceted oral health promotion intervention reduced Aboriginal children's intake of sugars from discretionary foods at 2 years of age. We conducted a single-blind, parallel-arm randomised controlled trial involving women who were pregnant or had given birth to an Aboriginal child in the previous 6 weeks. The treatment group received anticipatory guidance, Motivational Interviewing, health and dental care for mothers during pregnancy and children at 6, 12 and 18 months. The control group received usual care. The key dietary outcome was the percent energy intake from sugars in discretionary foods (%EI), collected from up to three 24-h dietary recalls by trained research officers who were blind to intervention group. Secondary outcomes included intake of macronutrients, food groups, anthropometric z scores (weight, height, BMI and mid-upper arm circumference) and blood pressure. We enrolled 224 children to the treatment group and 230 to the control group. Intention-to-treat analyses showed that the %EI of sugars in discretionary foods was 1·6 % lower in the treatment group compared with control (95 % CI -3·4, 0·2). This culturally appropriate intervention at four time-points from pregnancy to 18 months resulted in small changes to 2-year-old Aboriginal children's diets, which was insufficient to warrant broader implementation of the intervention. Further consultation with Aboriginal communities is necessary for understanding how to improve the diet and diet-related health outcomes of young Aboriginal children.
原住民儿童与非原住民儿童的饮食及口腔健康存在显著差异。饮食和口腔健康都与长期健康问题相关。我们旨在调查一项符合文化习俗的多方面口腔健康促进干预措施是否能降低原住民儿童两岁时从自由支配食物中摄入的糖分。我们开展了一项单盲、平行组随机对照试验,研究对象为怀孕或在过去六周内生育了原住民儿童的女性。治疗组在孕期以及儿童6个月、12个月和18个月时接受了前瞻性指导、动机性访谈、母亲的健康及牙科护理。对照组接受常规护理。关键饮食结果是从自由支配食物中摄入的糖分占能量摄入的百分比(%EI),由对干预组不知情的训练有素的研究人员通过最多三次24小时饮食回顾收集。次要结果包括宏量营养素、食物组的摄入量、人体测量学z评分(体重、身高、BMI和上臂中部周长)以及血压。我们将224名儿童纳入治疗组,230名儿童纳入对照组。意向性分析显示,与对照组相比,治疗组从自由支配食物中摄入的糖分的%EI低1.6%(95%CI -3.4, 0.2)。从孕期到18个月这四个时间点开展的这项符合文化习俗的干预措施,使两岁原住民儿童的饮食有了微小变化,但不足以保证该干预措施得到更广泛的实施。有必要与原住民社区进一步协商,以了解如何改善原住民幼儿的饮食及与饮食相关的健康结果。