Childhood obesity and dental caries: an ecological investigation of the shape and moderators of the association
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RESEARCH ARTICLE
Childhood obesity and dental caries: an ecological investigation of the shape and moderators of the association Vahid Ravaghi1* , Amir Rezaee2, Miranda Pallan3 and Alexander John Morris1
Abstract Background: Despite sharing a common risk factor in dietary sugars, the association between obesity and dental caries remains unclear. We investigated the association between obesity and dental caries in young children in England in an ecological study. Methods: We analysed data from 326 lower tier English local authorities. Data on obesity and dental caries were retrieved from 2014/15 to 2016/17 National Child Measurement Programme and 2016/17 National Dental Epidemiology Programme. We used fractional polynomial models to explore the shape of the association between obesity and dental caries. We also examined the modifying effect of deprivation, lone parenthood, ethnicity, and fluoridation. Results: Best fitting second order fractional polynomial models did not provide better fit than the linear models for the association between obesity and prevalence and severity of dental caries; therefore, the linear model was found suitable. Despite significant association, after adjusting for the effect of deprivation, obesity was neither associated with prevalence (coefficient = 0.2, 95% CI − 0.71, 0.75), nor with severity (coefficient = 0.001, 95% CI − 0.03, 0.03) of dental caries. In fully adjusted models, the proportion of white ethnicity and being in fluoridated areas were associated with a decrease in dental caries. The association between obesity and dental caries was moderated by the effect of deprivation, white ethnicity, and lone parenthood. Conclusions: The association between obesity and dental caries was linear and moderated by some demographic factors. Consequently, interventions that reduce obesity and dental caries may have a greater impact on specific groups of the population. Keywords: Obesity, Decay, Children, Teeth Introduction Childhood obesity is one of the most serious global public health challenges, with mean Body Mass Index (BMI) increasing globally in past decades in most regions [1]. Children with overweight and obesity are at greater risk of obesity in adulthood and developing related conditions such as diabetes and cardiovascular diseases at a younger *Correspondence: [email protected] 1 School of Dentistry, University of Birmingham, 5 Mill Pool, Birmingham B5 7EG, UK Full list of author information is available at the end of the article
age [2]. Despite a declining prevalence seen in westernised high income countries, dental caries also continues be an important global public health problem [3]. In England, around a quarter of children aged 4 to 5 years of age are living with overweight or obesity [4] and a similar proportion (23%) of children aged 5 years have experienced dental caries [5]. Like obesity, dental caries has a high impact on individuals and health services, for example the majority of admissions to hospital for children in England in the period
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