Fermentable carbohydrates intake and dental caries in adolescents under household food insecurity: a counterfactual analysis

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Abstract
Purpose: To evaluate the association between fermentable carbohydrate consumption and occurrence of dental caries according to the level of food insecurity (FI) at home. Methods: Cross-sectional study nested within a population-based cohort that began in 2010 with Brazilian preschoolers. Data were from the fifth follow-up wave, including adolescents aged 14–18 years. Dental caries was assessed using the International Caries Detection and Assessment System (ICDAS), considering the number of cavitated teeth. FI was measured with the Brazilian Food Insecurity Scale (EBIA). Fermentable carbohydrate consumption was categorized by self-reported frequency of cariogenic food intake. Demographic and socioeconomic variables were collected as confounders. Associations were estimated using Poisson regression, overall and stratified by FI status, and presented as Mean Ratios (MR) with 95% confidence intervals (CI). A non-linear Blinder-Oaxaca decomposition was applied to explore the FI impact. Results: The sample comprised 300 adolescents. After adjustment, daily fermentable carbohydrates consumption was associated with more cavitated lesions (MR 2.02; 95% CI 1.46–2.81). In the stratified analysis, the association was stronger among those with FI (MR 4.88; 95% CI 1.99–11.96), but not significant in adolescents without FI (MR 1.18; 95% CI 0.75–1.86). The decomposition showed a 95% difference in caries levels between fermentable carbohydrates intake groups; 16% was explained by observed variables mainly household income (9.5%) and FI (6.5%) and 72% by unmeasured factors. Conclusion: Daily fermentable carbohydrates consumption in FI adolescents is associated with higher rates of cavitated carious lesions, reinforcing the need for policies integrating dietary habits and food security to improve oral health outcomes.
Funding Information
  • Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (process 001)
  • Universidade Federal de Santa Maria

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