G-Computation Quantifying Caries Reduction by World Health Organization Sugar Limits in Children.

Area of Science:

• Public Health
• Pediatric Dentistry
• Nutrition Science

Background:

• Noncommunicable diseases, including dental caries, are linked to high free sugar intake (FSI).
• The World Health Organization (WHO) recommends FSI below 10% and ideally below 5% of estimated energy requirement (EER) to prevent these conditions.
• Despite recommendations, progress in reducing FSI to prevent early childhood caries (ECC) has been minimal.

Purpose of the Study:

• To quantify the impact of reducing FSI to WHO-recommended thresholds on decayed, missing, and filled surfaces (dmfs) scores in young children.
• To identify empirical thresholds for FSI associated with dmfs in early childhood.

Main Methods:

• Analysis of data from 2,182 Australian children in the SMILE birth cohort.
• Utilized G-computation analysis to estimate counterfactual dmfs scores under reduced FSI scenarios (below 10% and 5% EER).
• Conducted dose-response analysis using restricted cubic splines to model dmfs as a function of continuous FSI.

Main Results:

• Reducing FSI to <10% or <5% EER was estimated to reduce dmfs by 1.3 and 1.5, respectively, in the general preschool population (84% and 97% attributable fractions).
• In high-risk children, reductions in dmfs were more substantial, with absolute reductions of 4.4-4.5 and attributable fractions of 75-99%.
• An empirical threshold for increased dmfs was identified at approximately 6.25 g/day (2.5% EER), lower than WHO guidelines.

Conclusions:

• Reducing FSI to below 10% EER is crucial for all children, with a target below 5% recommended for high-risk groups.
• Findings provide evidence to support clinical guidance and public health interventions aimed at lowering FSI in early childhood.
• Further research in diverse settings, including low- and middle-income countries, is needed to inform global sugar reduction policies.