Te Kaupeka Oranga, Faculty of Health, Te Whare Wānanga o Waitaha, University of Canterbury, Christchurch, Aotearoa, New Zealand.
School of Clinical Medicine, Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia.
Community Dent Oral Epidemiol. 2023 Dec;51(6):1109-1117. doi: 10.1111/cdoe.12837. Epub 2023 Jan 20.
The relationship between childhood anthropometric measurements and dental caries has an inconsistent evidence-base. This study investigated dental caries experience and body mass index (BMI) measurements of children aged 4 years in a national cohort, after accounting for key confounding variables.
A near whole-population cross-sectional study of children who had a health and developmental assessment, as part of the nationwide B4 School Check screening program, conducted in Aotearoa | New Zealand (ANZ) between 1 July 2010 and 30 June 2021 was studied. The extracted database included 582 820 children, of whom 572 523 (98.2%) had valid BMI and oral health records. Dental caries experience was derived from the 'lift the lip' oral health screening, and measured height and weight were used to calculate sex-specific BMI-for-age z-scores (BMIz). Analyses were adjusted for age, sex, ethnicity and area-level deprivation. Modified Poisson regression models using 2-degree fractional polynomial curves for BMIz were employed.
In the extracted sample, the median age was 4.3 years (interquartile range: 4.1-4.5 years), 283 565 (48.7%) were female, 135 734 (23.4%) and 74 237 (12.8%) were identified as Māori and Pacific, respectively, and 140 931 (24.4%) lived in the most deprived areas of ANZ. Overall, 81 926 (14.2%) had dental caries identified. In unadjusted analyses, a significant J-shaped association was observed between dental caries experience and BMIz. However, in the adjusted analysis, a significant flattened S-shaped association was found; those with lower BMIz had lower predicted probabilities of dental caries experience. Large differences in predicted probabilities were observed between different sex, ethnicity and area-level deprivation groups.
This study found significant non-linear associations between dental caries experience and BMI in 4-year-old children. However, the inclusion of confounders importantly changed the shape of this non-linear association. Sex, ethnicity and area-level deprivation inequalities had a greater impact on dental caries experience than BMI.
儿童人体测量学指标与龋齿之间的关系的证据基础并不一致。本研究在考虑了主要混杂变量后，调查了新西兰全国队列中 4 岁儿童的龋齿患病情况和体重指数（BMI）测量值。
对参加全国 B4 学校检查筛查计划的儿童进行了一项近乎全人群的横断面研究，该研究于 2010 年 7 月 1 日至 2021 年 6 月 30 日在新西兰（ANZ）进行。提取的数据库包括 582820 名儿童，其中 572523 名（98.2%）有有效的 BMI 和口腔健康记录。龋齿患病情况由“掀唇”口腔健康筛查得出，身高和体重的测量值用于计算性别特异性 BMI 年龄 z 分数（BMIz）。分析调整了年龄、性别、种族和地区层面的贫困程度。使用 BMIz 的 2 度分数多项式曲线的修正泊松回归模型进行分析。
在提取的样本中，中位年龄为 4.3 岁（四分位距：4.1-4.5 岁），283565 名（48.7%）为女性，135734 名（23.4%）和 74237 名（12.8%）被确定为毛利人和太平洋岛民，140931 名（24.4%）居住在 ANZ 最贫困地区。总体而言，81926 名（14.2%）儿童有龋齿。在未调整分析中，观察到龋齿患病情况与 BMIz 之间存在显著的 J 形关联。然而，在调整分析中，发现了显著的扁平 S 形关联；BMIz 较低的儿童龋齿患病的预测概率较低。在不同的性别、种族和地区贫困程度群体之间，预测概率存在显著差异。
本研究发现，4 岁儿童的龋齿患病情况与 BMI 之间存在显著的非线性关联。然而，混杂因素的纳入显著改变了这种非线性关联的形状。性别、种族和地区贫困程度对龋齿患病情况的影响大于 BMI。
