Sugar consumption and early childhood caries: a systematic review and meta-analysis of cohort studies

The aim of this systematic literature review and meta-analysis was to answer the following research question: "Is sugar consumption associated with early childhood caries among children under 6 years of age in cohort studies?". The following electronic databases were accessed from December 2020 to May 2025 to identify the existing literature: Bireme, Pubmed/Medline, Scielo, Scopus, and Web of Science. Studies considered eligible for this systematic review were those that investigated sugar consumption as the main exposure and early childhood caries (ECC) as the outcome. Study selection and data extraction were performed independently by two reviewers. Study quality was assessed using the Joanna Briggs Institute (JBI) checklist for cohort studies scale. The search strategy retrieved 718 studies. After title and abstract screening, 59 were selected for full-text review, leading to the inclusion of 17 original studies in this systematic review. Finally, nine studies provided sufficient data for a meta-analysis. The association between sugar consumption and ECC was consistent across most of the cohort studies included in this review, which reported that higher sugar consumption was associated with higher prevalence of dental caries. The pooled effect estimate from the meta-analysis yielded an OR of 1.59 and a 95% CI (1.50-1.68), indicating that children who consumed sugar in early childhood were 59% more likely to develop caries compared to those who did not consume sugar. The included studies had a low risk of bias. Our systematic review and meta-analysis confirmed the association between sugar consumption and ECC in longitudinal cohort studies.