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Quantitative relationship between free sugars intake and early childhood caries among preschoolers in Sri Lanka
S A Mututanthri1, T Thoradeniya2, R Harris3
1Health Promotion Bureau, Ministry of Health, Colombo 10, Sri Lanka.
Insights
To prevent dental caries, limit children's free sugar intake to less than 5% of total energy or consume less than once daily. This study identified key sugar intake levels for optimal caries prevention in Sri Lankan children.
Area of Science:
- Public Health
- Pediatric Dentistry
- Nutrition Science
Background:
- The World Health Organization (WHO) has established sugar intake recommendations, but further research is needed to understand their application in specific contexts.
- Dental caries remains a significant public health issue in primary dentition, necessitating evidence-based dietary guidelines.
Purpose of the Study:
- To determine the free sugars intake levels associated with minimal risk of dental caries in primary dentition.
- To provide data for refining dietary recommendations for children in Sri Lanka.
Main Methods:
- A study involving 813 children aged 4-5 years in the Colombo district, Sri Lanka, utilizing probability proportionate to size and cluster sampling.
- Validated a quantitative food frequency questionnaire to assess free sugars intake and clinically evaluated dental caries using the dmft index.
- Employed Receiver Operating Characteristic (ROC) curves to identify optimal cut-off values for free sugars intake related to caries risk.
Main Results:
- The median free sugars intake was 57.9 g/day (21.1% of total energy), consumed 4 times daily.
- Dental caries prevalence was 42.9%. Free sugars intake percentage and frequency were significantly associated with caries (p < 0.001).
- A threshold of 4% of total energy (approx. 12 g/day) was identified to discriminate against high caries risk. Consuming sugar once daily showed 97% sensitivity in identifying caries. These findings were independent of toothbrushing habits with fluoridated toothpaste.
Conclusions:
- For optimal caries prevention, children's free sugar intake should be limited to less than 5% of total energy intake or consumed less than once daily.
- The study provides crucial data for policymakers and dental clinicians in Sri Lanka to update dietary recommendations.
- These findings will be disseminated through public health information materials and incorporated into national oral health guidelines.
Introduction:
Before implementing the WHO sugar recommendations, more studies are needed concerning its application to given contexts.
Objective:
To identify free sugars intake levels associated with a minimum caries risk in primary dentition METHODS: Using probability proportionate to size technique and cluster sampling, 813 children aged 4-5-years were selected from preschools in the Colombo district, Sri Lanka. A 67-item quantitative food frequency questionnaire was developed and validated to evaluate free sugars intake. Dental caries was assessed clinically using dmft index. For the selection of cut-off values for free sugars intake levels, ROC curves were used.
Results:
The median (IQR) amount of free sugars intake was 57.9 (33.2 -95.8) g/day or 21.1 % (12.5 %-35.9 %) of total energy requirement, with a frequency of 4.0 (2.7-6.1) times/day. Dental caries prevalence was 42.9 % (n = 349). Among all possible risk factors, free sugars intake as a percentage of total energy requirement (p < 0.001) and frequency of free sugars intake (p < 0.001) were significantly associated with the presence of dental caries. The percentage of free sugars that discriminates against a possible highest number of children with dental caries (99 %) was determined as 4 %, of the total energy requirement of a child, which is approximately 12 g/day (3 level teaspoons/day). Sugar intake once a day has a 97 % sensitivity in identifying children with dental caries. These cut-off values do not differ among the group who brush twice a day with fluoridated toothpaste.
Conclusion:
For optimal caries prevention, children's free sugar intake should limit to <5 % of their total energy intake or consume less frequently than once daily.
Clinical Significance:
This study provides facts that policy makers and dental clinicians can use for dietary recommendations in Sri Lanka, which they will include in the next revision of the booklet, "Uniform Oral Health Messages for Sri Lankans". Additionally, health professionals and health information materials will disseminate these recommendations to the public.
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