Folayan Morenike O, El Tantawi Maha, Ramos-Gomez Francisco, Sabbah Wael
Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
PeerJ. 2020 Oct 1;8:e9413. doi: 10.7717/peerj.9413. eCollection 2020.
This ecological study examined the associations between the prevalence of early childhood caries (ECC), overweight, country's per capita sugar consumption and duration of exclusive breastfeeding.
Per capita consumption of sugar in kilograms, percentage of children exclusively breastfed until 6 months of age, percentage of 0-5-year-old children with overweight status, and percentage of 3-5-year-old children with ECC were compared among low-income countries (LICs), middle-income countries (MICs) and high-income countries (HICs). The association between the prevalence of ECC and the study variables, and the effect modification by income region were assessed using multivariable linear regression models. Regression coefficients, confidence intervals, partial eta squared and -values for effect modification were calculated.
The per capita sugar consumption in LICs was significantly lower than in MICs ( = 0.001) and HICs ( < 0.001). The percentage of infants who exclusively breastfed up to 6 months was significantly lower in HICs than in LICs ( < 0.001) and MICs ( = 0.003). The prevalence of overweight was significantly lower in LICs than in MICs ( < 0.001) and HICs ( = 0.021). The prevalence of ECC was significantly lower in HICs than in MICs ( < 0.001). Income was a significant modifier of the associations between the prevalence of ECC, per capita sugar consumption ( = 0.005), and exclusive breastfeeding up to 6 months ( = 0.03). The associations between the prevalence of ECC and per capita sugar consumption at the global level and for MICs were stronger (partial eta squared = 0.05 and 0.13 respectively) than for LICs and HICs (partial eta squared <0.0001 and 0.003 respectively). Only in MICs was there a significant association between the prevalence of ECC and per capita sugar consumption ( = 0.002), and between the prevalence of ECC and the percentage of children exclusively breastfed up to 6 months ( = 0.02).
Though the quantity of sugar consumption and exclusive breastfeeding may be a significant risk indicator for ECC in MICs, sugar consumption may be more of a risk indicator for ECC in HICs than in LICs, and vice versa for exclusive breastfeeding. Although ECC and overweight are both sugar-related diseases, we found no significant relationship between them.
本生态学研究探讨了幼儿龋齿（ECC）患病率、超重、国家人均糖消费量与纯母乳喂养持续时间之间的关联。
比较了低收入国家（LICs）、中等收入国家（MICs）和高收入国家（HICs）的人均糖消费量（千克）、6个月龄前纯母乳喂养儿童的百分比、0至5岁超重儿童的百分比以及3至5岁患ECC儿童的百分比。使用多变量线性回归模型评估ECC患病率与研究变量之间的关联以及收入区域的效应修正。计算回归系数、置信区间、偏 eta 平方和效应修正的p值。
LICs的人均糖消费量显著低于MICs（p = 0.001）和HICs（p < 0.001）。HICs中6个月龄前纯母乳喂养婴儿的百分比显著低于LICs（p < 0.001）和MICs（p = 0.003）。LICs中超重患病率显著低于MICs（p < 0.001）和HICs（p = 0.021）。HICs中ECC患病率显著低于MICs（p < 0.001）。收入是ECC患病率、人均糖消费量（p = 0.005）和6个月龄前纯母乳喂养（p = 0.03）之间关联的显著效应修正因素。全球层面以及MICs中ECC患病率与人均糖消费量之间的关联（偏 eta 平方分别为0.05和0.13）比LICs和HICs更强（偏 eta 平方分别<0.0001和0.003）。仅在MICs中，ECC患病率与人均糖消费量之间存在显著关联（p = 0.002），且ECC患病率与6个月龄前纯母乳喂养儿童的百分比之间存在显著关联（p = 0.02）。
虽然糖消费量和纯母乳喂养量可能是MICs中ECC的重要风险指标，但糖消费在HICs中可能比在LICs中更是ECC的风险指标，纯母乳喂养则反之。尽管ECC和超重都是与糖相关的疾病，但我们发现它们之间没有显著关系。
