School of Public Health, Curtin University, Perth, Australia.
Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia.
Am J Clin Nutr. 2020 Apr 1;111(4):821-828. doi: 10.1093/ajcn/nqaa012.
Recent reviews have proposed a causal relationship between prolonged breastfeeding and early childhood caries (ECC), but the evidence to date is inconsistent, with few cohort studies and limited investigation of key confounders.
This study aimed to investigate the relationship between dietary practices and early childhood caries in a birth cohort of Australian preschoolers.
Participants underwent a standardized dental examination at 2-3 y of age to determine the prevalence of ECC (based on the presence of decayed, missing, or filled tooth surfaces). Breastfeeding practices were reported at 3, 6, 12, and 24 mo of age. Intakes of free sugars were assessed at 1 and 2 y of age. Multivariable regression models generated prevalence ratios (PR) for the association between ECC and breastfeeding duration, and between ECC and sleep feeding practices at 1 y, controlling for sociodemographic factors and free sugars intake.
There was no independent association between breastfeeding beyond 1 y of age and ECC (PR 1.42, 95% CI: 0.85, 2.38), or between breastfeeding to sleep and ECC (PR 1.12, 95% CI: 0.67, 1.88), although the direction of effect was suggestive of an association. The only factors independently associated with ECC were high free sugars intakes (PR 1.97, 95% CI: 1.13, 3.44), and greater socioeconomic disadvantage (PR 2.15, 95% CI: 1.08, 4.28). Most participants who were breastfed at 1 y of age had ceased by 18 mo or 2 y.
Breastfeeding practices were not associated with ECC. Given the wide-ranging benefits of breastfeeding, and the low prevalence of sustained breastfeeding in this study and Australia in general, recommendations to limit breastfeeding are unwarranted, and breastfeeding should be promoted in line with global and national recommendations. To reduce the prevalence of early childhood caries, improved efforts are needed to limit foods high in free sugars.
最近的综述提出，延长母乳喂养与幼儿龋（ECC）之间存在因果关系，但迄今为止的证据并不一致，队列研究较少，对关键混杂因素的研究也有限。
本研究旨在调查澳大利亚学龄前儿童队列中饮食行为与幼儿龋之间的关系。
参与者在 2-3 岁时接受标准化牙科检查，以确定 ECC 的患病率（根据存在龋齿、缺失或填充的牙齿表面来确定）。在 3、6、12 和 24 个月时报告母乳喂养情况。在 1 和 2 岁时评估游离糖摄入量。多变量回归模型生成 ECC 与母乳喂养持续时间之间以及 ECC 与 1 岁时睡眠喂养之间的关联的患病率比（PR），控制社会人口因素和游离糖摄入量。
1 岁以后母乳喂养与 ECC 之间没有独立的关联（PR1.42，95%CI：0.85，2.38），也没有母乳喂养与睡眠之间与 ECC 的关联（PR1.12，95%CI：0.67，1.88），尽管影响方向表明存在关联。唯一与 ECC 独立相关的因素是高游离糖摄入量（PR1.97，95%CI：1.13，3.44）和更大的社会经济劣势（PR2.15，95%CI：1.08，4.28）。在 1 岁时母乳喂养的大多数参与者在 18 个月或 2 岁时已经停止母乳喂养。
母乳喂养与 ECC 无关。鉴于母乳喂养的广泛益处，以及本研究和澳大利亚普遍存在的持续母乳喂养率较低，限制母乳喂养的建议是不合理的，应根据全球和国家建议促进母乳喂养。为了降低幼儿龋的患病率，需要加大努力限制高游离糖食物的摄入。
