Association between added sugar intake and dental caries in Yup’ik children using a novel hair biomarker

BMC Oral Health

Dane Lenaker¹  Eliza Orr³  Lloyd Mancl²  Diane O’Brien³  Scarlett Hopkins³  Donald L. Chi² 

[1] Yukon Kuskokwim Health Corporation, Dentistry Department, Bethel, AK, USA;Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle 98195, WA, USA;University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, USA

关键词: Oral health interventions;    Oral health disparities;    Alaska Native children;    Dental caries;    Sugar-sweetened beverages;    Dietary biomarkers;    Added sugars;   

Others  :  1229041
DOI  :  10.1186/s12903-015-0101-z

 received in 2015-07-21, accepted in 2015-10-01,  发布年份 2015

【 摘 要 】

Background

Dental caries (tooth decay) is a significant public health problem in Alaska Native children. Dietary added sugars are considered one of the main risk factors. In this cross-sectional pilot study, we used a validated hair-based biomarker to measure added sugar intake in Alaska Native Yup’ik children ages 6–17 years (N = 51). We hypothesized that added sugar intake would be positively associated with tooth decay.

Methods

A 66-item parent survey was administered, a hair sample was collected from each child, and a dental exam was conducted. Added sugar intake (grams/day) was measured from hair samples using a linear combination of carbon and nitrogen ratios. We used linear and log-linear regression models with robust standard errors to test our hypothesis that children with higher added sugar intake would have a higher proportion of carious tooth surfaces.

Results

The mean proportion of carious tooth surfaces was 30.8 % (standard deviation: 23.2 %). Hair biomarker-based added sugar intake was associated with absolute (6.4 %; 95 % CI: 1.2 %, 11.6 %; P = .02) and relative increases in the proportion of carious tooth surfaces (24.2 %; 95 % CI: 10.6 %, 39.4 %; P < .01). There were no associations between self-reported measures of sugar-sweetened food and beverage intake and tooth decay.

Conclusions

Added sugar intake as assessed by hair biomarker was significantly and positively associated with tooth decay in our sample of Yup’ik children. Self-reported dietary measures were not associated tooth decay. Most added sugars were from sugar-sweetened fruit drinks consumed at home. Future dietary interventions aimed at improving the oral health of Alaska Native children should consider use of objective biomarkers to assess and measure changes in home-based added sugar intake, particularly sugar-sweetened fruit drinks.

【 授权许可】

   
2015 Chi et al.

【 图 表 】

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【 参考文献 】

• [1]Alaska natives commission, final report, volume II. 1994. Available at http://www. alaskool.org/resources/anc2/anc2_toc.html#top. Accessed on November 25, 2014
• [2]Marcenes W, Kassebaum NJ, Bernabé E, Flaxman A, Naghavi M, Lopez A, Murray CJ. Global burden of oral conditions in 1990–2010: a systematic analysis. J Dent Res. 2013; 92(7):592-7.
• [3]Dental caries in rural Alaska Native children – Alaska, 2008. MMWR Morb Mortal Wkly Rep. 2011; 60:1275-8.
• [4]The 2010 Indian health service oral health survey of American Indian and Alaska native preschool children. U.S. Department of Health and Human Services, Indian Health Service, Rockville, MD; 2013.
• [5]Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton-Evans G, Eke PI, Beltrán-Aguilar ED, Horowitz AM, Li CH. Trends in oral health status: United States, 1988–1994 and 1999–2004. Vital Health Stat 11. 2007; 248:1-92.
• [6]Casamassimo PS, Thikkurissy S, Edelstein BL, Maiorini E. Beyond the dmft: the human and economic cost of early childhood caries. J Am Dent Assoc. 2009; 140:650-7.
• [7]Chi DL, Masterson EE. A serial cross-sectional study of pediatric inpatient hospitalizations for non-traumatic dental conditions. J Dent Res. 2013; 92:682-8.
• [8]Hollister MC, Weintraub JA. The association of oral status with systemic health, quality of life, and economic productivity. J Dent Educ. 1993; 57:901-12.
• [9]Horowitz AM, Kleinman DV. Oral health literacy: a pathway to reducing oral health disparities in Maryland. J Public Health Dent. 2012; 72:S26-30.
• [10]Li Y, Wang W. Predicting caries in permanent teeth from caries in primary teeth: an eight-year cohort study. J Dent Res. 2002; 81:561-6.
• [11]Holve S. An observational study of the association of fluoride varnish applied during well child visits and the prevention of early childhood caries in American Indian children. Matern Child Health J. 2008; 12 Suppl 1:64-7.
• [12]Griffin SO, Jones K, Tomar SL. An economic evaluation of community water fluoridation. J Public Health Dent. 2001; 61:78-86.
• [13]Gessner BD, Beller M, Middaugh JP, Whitford GM. Acute fluoride poisoning from a public water system. N Engl J Med. 1994; 330:95-9.
• [14]Tiwari T, Quissell DO, Henderson WG et al.. Factors associated with oral health status in American Indian children. J Racial Ethn Health Disparities. 2014; 1:148-56.
• [15]Moyer VA. Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement. Pediatrics. 2014; 133:1102-11.
• [16]Touger-Decker R, Mobley CC. Position of the American Dietetic Association: oral health and nutrition. J Am Diet Assoc. 2007; 107:1418-28.
• [17]Pollard MA. Potential cariogenicity of starches and fruits as assessed by the plaque-sampling method and an intraoral cariogenicity test. Caries Res. 1995; 29:68-74.
• [18]Lingström P, van Houte J, Kashket S. Food starches and dental caries. Crit Rev Oral Biol Med. 2000; 11:366-80.
• [19]Reedy J, Krebs-Smith SM. Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States. J Am Diet Assoc. 2010; 110:1477-84.
• [20]Slining MM, Mathias KC, Popkin BM. Trends in food and beverage sources among US children and adolescents: 1989–2010. J Acad Nutr Diet. 2013; 113:1683-94.
• [21]Wang YC, Bleich SN, Gortmaker SL. Increasing caloric contribution from sugar-sweetened beverages and 100 % fruit juices among US children and adolescents, 1988–2004. Pediatrics. 2008; 121:e1604-14.
• [22]Kolahdooz F, Simeon D, Ferguson G, Sharma S. Development of a quantitative food frequency questionnaire for use among the Yup’ik people of Western Alaska. PLoS ONE. 2014; 9:e100412.
• [23]Evans EW, Hayes C, Palmer CA, Bermudez OI, Cohen SA, Must A. Dietary intake and severe early childhood caries in low-income, young children. J Acad Nutr Diet. 2013; 113(8):1057-61.
• [24]Marshall TA, Levy SM, Broffitt B, Warren JJ, Eichenberger-Gilmore JM, Burns TL, Stumbo PJ. Dental caries and beverage consumption in young children. Pediatrics. 2003; 112(3 Pt 1):e184-91.
• [25]Early childhood caries in indigenous communities. Pediatrics. 2011; 127:11908.
• [26]Chi DL. Reducing Alaska Native paediatric oral health disparities: a systematic review of oral health interventions and a case study on multilevel strategies to reduce sugar-sweetened beverage intake. Int J Circumpolar Health. 2013; 72:21066.
• [27]American Dental Association News. ADA urges more sugars, oral health research. http://www.ada.org/en/publications/ada-news/2015-archive/april/ada-urges-more-sugars-oral-health-research?nav=news. Accessed on May 13, 2015.
• [28]Prentice RL, Mossavar-Rahmani Y, Huang Y, Van Horn L, Beresford SA et al.. Evaluation and comparison of food records, recalls, and frequencies for energy and protein assessment by using recovery biomarkers. Am J Epidemiol. 2011; 174:591-603.
• [29]Subar AF, Kipnis V, Troiano RP, Midthune D, Schoeller DA et al.. Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: the OPEN study. Am J Epidemiol. 2003; 158:1-13.
• [30]Bingham S, Luben R, Welch A, Tasevska N, Wareham N, Khaw KT. Epidemiologic assessment of sugars consumption using biomarkers: comparisons of obese and nonobese individuals in the European Prospective Investigation of cancer Norfolk. Cancer Epidemiol Biomarkers Prev. 2007; 16:1651-4.
• [31]Poppitt SD, Swann D, Black AE, Prentice AM. Assessment of selective under-reporting of food intake by both obese and non-obese women in a metabolic facility. Int J Obes Relat Metab Disord. 1998; 22:303-11.
• [32]Davy BM, Jahren AH, Hedrick VE, Comber DL. Association of δ 13 C in fingerstick blood with added-sugar and sugar-sweetened beverage intake. J Am Diet Assoc. 2011; 111:874-8.
• [33]Fakhouri THI, Jahren AH, Appel LJ, Chen LW, Alavi R, Anderson CAM. Serum carbon isotope values change in adults in response to changes in sugar-sweetened beverage intake. J Nutr. 2014; 144:902-5.
• [34]Jahren A, Saudek C, Yeung E, Kao W, Kraft R, Caballero B. An isotopic method for quantifying sweeteners derived from corn and sugar cane. Am J Clin Nutr. 2006; 84:1380-4.
• [35]Tasevska N, Runswick SA, McTaggart A, Bingham SA. Urinary sucrose and fructose as biomarkers for sugar consumption. Cancer Epidemiol Biomarkers Prev. 2005; 14:1287-94.
• [36]Tasevska N, Runswick SA, Welch AA, McTaggart A, Bingham SA. Urinary sugars biomarker relates better to extrinsic than to intrinsic sugars intake in a metabolic study with volunteers consuming their normal diet. Eur J Clin Nutr. 2009; 63:653-9.
• [37]Yeung EH, Saudek CD, Jahren AH, Kao WHL, Islas M et al.. Evaluation of a novel isotope biomarker for dietary consumption of sweets. Am J Epidemiol. 2010; 172:1045-52.
• [38]Haley S. 2013. Sugar and Sweeteners Outlook/SSS-M-293. ed. USDo Agriculture: Electronic Outlook Report from the Economic Research Service
• [39]Jahren AH, Bostic JN, Davy BM. The potential for a carbon stable isotope biomarker of dietary sugar intake. J Anal At Spectrom. 2014; 29:795-816.
• [40]O’Brien DM. Stable Isotope Ratios as Biomarkers of Diet for Health Research. Annu Rev Nutr. Epub 2015 Jul 17.
• [41]Thompson FE, Subar AF. Dietary assessment methodology. Nutrition in the prevention and treatment of disease. Coulston AM, Boushey CJ, editors. Academic Press, San Diego, CA; 2008.
• [42]Nash S, Kristal A, Bersamin A, Choy K, Hopkins S et al.. Isotopic estimates of sugar intake are related to chronic disease risk factors but not obesity in an Alaska native (Yup’ik) study population. Eur J Clin Nutr. 2014; 68:91-6.
• [43]U.S. Census Bureau. State and County QuickFacts. Bethel Census Area, Alaska. Available at http://quickfacts.census.gov/qfd/states/02/02050.html. Accessed on November 28, 2014.
• [44]Neuhouser ML, Lilley S, Lund A, Johnson DB. Development and validation of a beverage and snack questionnaire for use in evaluation of school nutrition policies. J Am Diet Assoc. 2009; 109:1587-92.
• [45]Nash SH, Kristal AR, Bersamin A, Hopkins SE, Boyer BB, O’Brien DM. Carbon and nitrogen stable isotope ratios predict intake of sweeteners in a Yup’ik study population. J Nutr. 2013; 143:161-5.
• [46]Nash SH, Kristal AR, Hopkins SE, Boyer BB, O’Brien DM. Stable isotope models of sugar intake using hair, red blood cells, and plasma, but not fasting plasma glucose, predict sugar intake in a Yup’ik study population. J Nutr. 2014; 144:75-80.
• [47]Choy K, Nash SH, Kristal AR, Hopkins S, Boyer BB, O’Brien DM. The carbon isotope ratio of alanine in red blood cells is a new candidate biomarker of sugar-sweetened beverage intake. J Nutr. 2013; 143:878-84.
• [48]A guide to oral health epidemiological investigations. WHO, Geneva; 1979.
• [49]Gomez J, Tellez M, Pretty IA, Ellwood RP, Ismail AI. Non-cavitated carious lesions detection methods: a systematic review. Community Dent Oral Epidemiol. 2013; 41(1):54-66.
• [50]Dye BA, Tan S, Smith V et al.. Trends in oral health status: United States, 1988–1994 and 1999–2004. Vital Health Stat. 2007; 11:1-92.
• [51]Zenger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986; 42:121-30.
• [52]Chankanka O, Levy SM, Marshall TA, et al. The associations between dietary intakes from 36 to 60 months of age and primary dentition non-cavitated caries and cavitated caries. J Public Health Dent. Epub 2012 Nov 8.
• [53]Nash SH, Kristal AR, Boyer BB, King IB, Metzgar JS, O’Brien DM. Relation between stable isotope ratios in human red blood cells and hair: implications for using the nitrogen isotope ratio of hair as a biomarker of eicosapentaenoic acid and docosahexaenoic acid. Am J Clin Nutr. 2009; 90:1642-7.
• [54]Johnson RK, Appel LJ, Brands M et al.. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2009; 120:1011-20.
• [55]Pan L, Li R, Park S, Galuska DA, Sherry B, Freedman DS. A longitudinal analysis of sugar-sweetened beverage intake in infancy and obesity at 6 years. Pediatrics. 2014; 134 Suppl 1:S29-35.
• [56]Nguyen S, Choi HK, Lustig RH, Hsu CY. Sugar-sweetened beverages, serum uric acid, and blood pressure in adolescents. J Pediatr. 2009; 154:807-13.
• [57]Kosova EC, Auinger P, Bremer AA. The relationships between sugar-sweetened beverage intake and cardiometabolic markers in young children. J Acad Nutr Diet. 2013; 113:219-27.
• [58]Xi B, Li S, Liu Z et al.. Intake of fruit juice and incidence of type 2 diabetes: a systematic review and meta-analysis. PLoS ONE. 2014; 9:e93471.
• [59]Avery A, Bostock L, McCullough F. A systematic review investigating interventions that can help reduce consumption of sugar-sweetened beverages in children leading to changes in body fatness. Hum Nutr Diet. Epub 2014 Sep 19.
• [60]Gittelsohn J, Laska MN, Karpyn A, Klingler K, Ayala GX. Lessons learned from small store programs to increase healthy food access. Am J Health Behav. 2014; 38:307-15.
• [61]Brickhouse TH, Haldiman RR, Evani B. The impact of a home visiting program on children’s utilization of dental services. Pediatrics. 2013; 132 Suppl 2:S147-52.
• [62]Zhen C, Brissette IF, Ruff RR. By ounce or by calorie: the differential effects of alternative sugar-sweetened beverage tax strategies. Am J Agric Econ. 2014; 96:1070-83.
• [63]Chi DL, Masterson EE, Carle AC, Mancl LA, Coldwell SE. Socioeconomic status, food security, and dental caries in US children: mediation analyses of data from the National Health and Nutrition Examination Survey, 2007–2008. Am J Public Health. 2014; 104:860-4.