Dietary Research to Reduce Children's Oral Health Disparities: An Exploratory Cross-Sectional Analysis of Socioeconomic Status, Food Insecurity, and Fast-Food Consumption

Burden of dental caries in individuals experiencing food insecurity: a systematic review and meta-analysis

CONTEXT

Food insecurity affects approximately 2.37 billion people worldwide. Individuals experiencing food insecurity are more likely to exhibit poor health-related endpoints. Dental caries, a highly prevalent noncommunicable disease, is modulated by an interplay between biological, behavioral, and environmental factors.

OBJECTIVE

This systematic review and meta-analysis aimed to assess whether individuals experiencing food insecurity were more likely to exhibit dental caries than individuals facing food security.

DATA SOURCES

The Web of Science, PubMed, Scopus, Embase, Ovid, CINAHL, LILACS, and APA PsycINFO databases were checked from inception to November 2021. Grey literature and Google Scholar were also examined. An updated search was conducted in August 2022. Observational studies were included if they evaluated the association between dental caries and food insecurity status.

DATA EXTRACTION

Data extraction was performed by two reviewers.

DATA ANALYSIS

Random-effects meta-analyses were conducted using R language. In total, 514 references were retrieved from databases, of which 14 articles were included in qualitative synthesis and 7 were merged into meta-analysis. The results of an inverse-variance meta-analysis (OR = 1.62; 95%CI, 1.01-2.60) and a meta-analysis of binary data (OR = 1.66; 95%CI, 1.36-2.02) demonstrated that food-insecure individuals were more likely to exhibit dental caries than food-secure individuals. Inverse-variance meta-analyses appraising multiple strata of food security also showed that individuals experiencing marginal food security (OR = 1.48; 95%CI, 1.28-1.72), individuals experiencing low food security (OR = 1.26; 95%CI, 1.01-1.57), and those experiencing very low food security (OR = 1.33; 95%CI, 1.04-1.71) were more likely to exhibit dental caries than individuals experiencing full food security.

CONCLUSION

Dental caries is associated with food insecurity. Individuals living with food insecurity are more likely to exhibit dental caries than those who have food security.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42021268582.

Sugar-sweetened beverage intake and convenience store shopping as mediators of the food insecurity-Tooth decay relationship among low-income children in Washington state

INTRODUCTION

There are oral health disparities in the U.S. and children in food-insecure households have a higher burden of tooth decay. Identifying the mechanisms underlying the food insecurity-tooth decay relationship could inform public health interventions. This study examined how sugar-sweetened beverage (SSB) intake and frequent convenience store shopping mediated the food insecurity-tooth decay relationship for lower-income children.

MATERIALS AND METHODS

Cross-sectional study data included a household survey, beverage questionnaire, and dental examination. The sample included 452 lower-income, racially-diverse, child-caregiver dyads in 2018 from King County in Washington state. The exposure was household food insecurity, the outcome was untreated decayed tooth surfaces, and the proposed mediators were SSB intake and frequent convenience store shopping (≥2 times/week). Causal mediation analyses via the potential outcomes framework was used to estimate natural indirect and direct effects.

RESULTS

Fifty-five percent of participants were in food-insecure households, the mean number of decayed tooth surfaces among children was 0.87 (standard deviation [SD] = 1.99), the mean SSB intake was 17 fluid ounces (fl/oz)/day (SD = 35), and 18% of households frequently shopped at a convenience store. After adjusting for confounders, household food insecurity and log-transformed SSB intake (fluid ounces/day) were positively associated with decayed tooth surfaces, but not at the a α = 0.05 level (mean ratio [MR] 1.60; 95% confidence interval [CI] 0.89, 2.88; p = .12 and MR 1.16; 95% CI 0.93, 1.46; p = .19, respectively). Frequent convenience store shopping was associated with 2.75 times more decayed tooth surfaces (95% CI 1.61, 4.67; p < .001). SSB intake mediated 10% of the food insecurity-tooth decay relationship (p = .35) and frequent convenience store shopping mediated 22% (p = .33).

CONCLUSIONS

Interventions aimed at addressing oral health disparities in children in food-insecure households could potentially focus on reducing intake of SSBs and improving access to healthful foods in lower-income communities.

Dietary interventions and nutritional impact on oral health and development: a review

Food and nutrients play a pivotal role in the development of dentition and oral health. While diet includes the overall forms of consumed foods, the nutrients include specific micro- (vitamins and minerals) and macro- (carbohydrates, proteins, and lipids) nutrients. As much as the assimilation of macro and micronutrients depends on proper oral health for ingesting food, oral health, in turn, depends on the availability of nutrients in the food so ingested. Age, certain medical conditions, socioeconomic status, and overall changes in the evolution of society determine the type of diet which in turn influences oral health. This article has touched upon certain salient aspects of these nutrients and their bearing on overall oral health and development.

Food insecurity is associated with self-reported oral health in school-age Ecuadorian children and is mediated by dietary and non-dietary factors

OBJECTIVE

The main objective was to investigate the association of household food insecurity (HFI) with child oral health. A secondary objective was to explore potential dietary and non-dietary mediators of the HFI-child oral health relationship.

DESIGN

Cross-sectional data from the nationally representative Ecuadorian National Health and Nutrition Survey (2018) were analysed. The data included self-reported child oral health, HFI (Food Insecurity Experience Scale), diet (FFQ) and oral care behaviours (toothbrushing frequency, toothpaste use). The association of HFI with the reported number of oral health problems was examined with stereotype logistic regression. Parallel mediation analysis was used to explore potential dietary (highly fermentable carbohydrate foods, plain water) and non-dietary (toothbrushing) mediators of the HFI-oral health relationship. Bias-corrected standard errors and 95 % CI were obtained using non-parametric bootstrapping (10 000 repetitions). Effect size was measured by percent mediation (PM).

SETTING

Ecuador.

PARTICIPANTS

5-17-year-old children (n 23 261).

RESULTS

HFI affected 23 % of child households. 38·5 % of children have at least one oral health problem. HFI was associated with a greater number of oral health problems: 1-2 problems (adjusted odds ratio (AOR) = 1·37; 95 % CI (1·15, 1·58); P = 0·0001), 3-4 problems (AOR = 2·21; 95 % CI (1·98, 2·44); P = 0·0001), 5-6 problems (AOR = 2·57; 95 % CI (2·27, 2·88); P = 0·0001). The HFI-oral health relationship was partially mediated by highly fermentable carbohydrate foods (PM = 4·3 %), plain water (PM = 1·8 %) and toothbrushing frequency (PM = 3·3 %).

CONCLUSIONS

HFI was associated with poorer child oral health. The HFI-oral health relationship was partially mediated by dietary and non-dietary factors. Longitudinal studies are needed to replicate our findings and investigate the role of other potential mediators.

Food insecurity and dental caries prevalence in children and adolescents: A systematic review and meta-analysis

BACKGROUND

Food insecurity (FI) is associated with dietary practices, which can act as a risk factor for dental caries.

AIM

This study aimed to investigate the relationship between FI and dental caries prevalence in children and adolescents.

DESIGN

MEDLINE (via PubMed), EMBASE, SCOPUS, ISI web of knowledge, Cochrane, and ProQuest Dissertations & Theses Global database (up to April 19, 2022) as well as reference lists were searched. Eligible studies compared dental caries prevalence in food-secure and food-insecure individuals younger than 19 years. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using a modified Newcastle-Ottawa Scale. Meta-analysis was performed, and the pooled odds ratio (OR) was calculated at 95% confidence interval (95% CI).

RESULTS

Among the 1350 retrieved records, 10 cross-sectional reports were selected for systematic review. Six studies involving 8631 participants were included in the meta-analysis. More than half of the reports were published within the period 2019-2021. All studies except one were judged as low risk of bias. Overall, the prevalence of dental caries was greater among the food-insecure children and adolescents (OR: 2.01, 95% CI: 1.52-2.65, p < .001, I² : 73.5%). Similarly, all three categories of FI were significantly associated with caries experience (marginal FI: OR: 1.88, 95% CI: 1.56-2.27, p < .001, I² : 0.0%; low FI: OR: 2.42, 95% CI: 1.42-4.14, p = .001, I² : 74.4%; very low FI: OR: 2.37, 95% CI: 1.88-3.00, p < .001, I² : 0.0%).

CONCLUSION

The results showed a significant association between FI status and dental caries in both childhood and adolescence; however, there was a lack of longitudinal studies for a better understanding of this association. Health policies leading to reduction in FI may also aim to reduce dental caries.

The association of food insecurity with tooth decay and periodontitis among middle-aged and older adults in the United States and Korea

INTRODUCTION

Food insecurity is an important social determinant of health, but there is limited understanding of its relationship with adult oral health. This study examined the associations between food insecurity and dental diseases (caries and periodontitis) among middle-aged and older adults in the United States and South Korea.

METHODS

This study focused on middle-aged (40-59 years) and older adults (>59 years) who participated in the 2011-2016 US National Health and Nutrition Examination Surveys (NHANES) or the 2013-2015 South Korean NHANES. The exposure was food insecurity severity (food secure/early-stage food insecurity/middle-stage or severe food insecurity) assessed using the 18-item US Household Food Security Survey Module. The two outcomes were any untreated tooth decay and periodontitis measured using the Modified Community Periodontal Index of Treatment Needs. Covariate-adjusted odds ratios (OR) with 95% confidence intervals (CI) were generated using multivariable logistic regression models.

RESULTS

Middle or severe food insecurity was associated with significantly higher odds of having untreated tooth decay than no food insecurity, but only among middle-aged adults in the United States (OR: 1.4, 95% CI 1.2, 1.9; P = .037) and Korea (OR = 1.8; 95% CI:1.0, 3.2; P = .036) and older adults in the United States (OR: 2.6, 95% CI 1.7, 4.0; P < .001). The associations between food insecurity and periodontitis were inconsistent across age group and country.

CONCLUSION

Differing cultural norms and access to dental services in the United States and South Korea may influence the relationship between food insecurity and oral health. Future research should explore how addressing food insecurity could help to promote the oral health of middle-aged and older adults in diverse sociocultural contexts.

Nutritional problems in childhood and adolescence: a narrative review of identified disparities

To inform programmes and policies that promote health equity, it is essential to monitor the distribution of nutritional problems among young individuals. Common nutritional problems include overall low diet quality, the underconsumption and overconsumption of certain dietary components, unhealthy meal and snack patterns, problematic feeding practices and disordered eating. The objective of the present narrative review was to summarise recent evidence of disparities among US children (2-19 years) according to age, sex, socio-economic status, ethnicity/race and rural-urban location. Searches in PubMed® and MEDLINE® were completed to identify peer-reviewed research studies published between January 2009 and January 2019. Findings from the ninety-nine reviewed studies indicate adolescent females, young individuals from lower socio-economic households and individuals who identify as non-Hispanic Black race are particularly vulnerable populations for whom targeted strategies should be developed to address evidence of increased risk with regards to multiple aspects of nutritional wellbeing. Limitations of the existing evidence relate to the accuracy of self-reported dietary data; the need for consistent definitions of disordered eating; the focus on individual dietary components v. patterns; the complexities of categorising socio-economic status, ethnicity/race, and rural and urban areas; and the cross-sectional, observational nature of most research designs. There is an urgent need for research to address these limitations and fill a large gap in evidence on rural-urban differences in nutritional problems. It will further be important for future studies to build greater understanding of how nutritional problems cluster among population groups.

Adolescent food insecurity: A review of contextual and behavioral factors

OBJECTIVE

The purpose of this review is to examine recent research on contextual and behavioral factors that will lead to better understanding of adolescent food insecurity and health outcomes.

DESIGN

A literature search for peer-reviewed, English language, research articles published between 2009 and 2019, using CINAHL, Embase^® , Pubmed, and the Cochrane Library.

SAMPLE

The final sample represents thirty studies on food insecurity with a sample including adolescents, and that employ a measure of food insecurity.

RESULTS

Variables of interest and results on topics such as weight-related factors, maternal parenting and behaviors, mental health, and adolescent-level behavioral factors are summarized.

CONCLUSION

Food insecurity is associated with poor adolescent health and mental health. All adolescents should be screened for food insecurity, involving pediatric and mental health care settings. Future research on adolescent food insecurity should explore parent and parenting factors, household composition and family dynamics, psychological factors, health behaviors, and stress; peer influences might also be an important area of research with adolescents. While previous research has relied on parents' reports, adolescents'experiences are unique, and they are willing and reliable research participants; they should be included in future food insecurity research.

How much does household food insecurity explain income inequalities in untreated dental caries?

BACKGROUND

The pathway by which socioeconomic disadvantages are manifested in the occurrence of dental caries remains unclear.

AIM

To explore how much the association between untreated dental caries and income inequalities is related to household food insecurity (HFI).

DESIGN

A population-based study was conducted with a sample of 466 12-year-old students. Dental caries was evaluated by an examiner who had undergone calibration exercises. HFI was assessed using the Food Insecurity Scale validated for Brazilian Portuguese. Poisson regression models were created to determine associations between dental caries and both household income and HFI. The proportion of the income effect on dental caries explained by HFI was determined by the variation in percentages between the crude prevalence ratio (PR_c ) for dental caries and this measure adjusted by HFI (PR_a ).

RESULTS

The prevalence of dental caries was higher among children from families with a per capita household income lower than US$ 71 (PR: 1.69; 95%CI: 1.15-2.49) or from US$ 71 to US$ 142 (PR: 1.50; 95%CI: 1.04-2.17). Moreover, 14% of the association between a low income and dental caries was explained by HFI.

CONCLUSIONS

Differences in the prevalence of dental caries in schoolchildren related to socioeconomic inequalities could partially be attributed to HFI in low-income families.

Validation of a Two-Item Food Security Screening Tool in a Dental Setting

Purpose: The United States is typically viewed as a wealthy country, yet not all households have access to enough food for an active, healthy life. The purpose of this study was to validate a two-item written food security screen that health providers may use to identify food insecurity in their patient populations.Methods: Data were obtained from 150 parents or guardians who brought a child to a dental appointment at The Center for Pediatric Dentistry, University of Washington, Seattle, Wash., USA. The sensitivity and specificity of two written questions were determined by comparing with the United States Department of Agriculture Six-item Short Form of the Food Security Survey Module.Results: The sample consisted of 141 surveys after those with critical questions left blank were removed. The prevalence of food insecurity was found to be 31 percent at the Center for Pediatric Dentistry. The six-item screen identified 44 foodinsecure families with an affirmative response to two or more questions. Compared with the six-item screen, the two-item screen was found to have 95.4 percent sensitivity and 83.5 percent specificity.Conclusions: The two-item food security screen was found to be sensitive and reasonably specific, providing a quick and accurate method to identify food-insecure families.

The relation of Dietary diversity score and food insecurity to metabolic syndrome features and glucose level among pre-diabetes subjects

INTRODUCTION

Prediabetes is considered as an increased risk factor for cardiovascular disease and overt diabetes and is the precursor stage of diabetes. Dietary Diversity Score (DDS) is recognized as an essential factor of a high-quality diet. However, diets with more varieties of food items might increase calorie intake and body weight. Therefore, this study was carried out to determine the association of DDS with metabolic syndrome features in adults with prediabetes.

METHODS

Three hundred subjects were randomly selected from participants who were undergone diabetes test screening program. Dietary intake was assessed by using a validated semi-quantitative food frequency questionnaire. DDS was calculated by scoring food intake as nine food groups. The 18-items USDA household food securities and International Physical Activity (IPAQ) were also measured. The metabolic syndrome was defined according to the Adult Treatment Panel III.

RESULTS

DDS mean for cases and controls were 4.43 and 4.9, respectively (p<0.005). The prevalence of food insecurity was 67/3% in cases and 55/4% in controls group. The decrease in metabolic syndrome probability was compatible with quartiles of DDS (the quartiles odds ratios: 0.6, 0.5, 0.4, 0.19, P=0.05). A higher DDS was associated with lower level of fasting blood glucose, HDL-cholesterol, TG and Waist circumference.

CONCLUSION

Lower DDS was associated with high probability of metabolic syndrome and with some features of it, like high fasting blood glucose. Therefore, it seems that increase in dietary diversity scores could prevent the pre diabetes development to overt diabetes.

Presence of Dental Caries Is Associated with Food Insecurity and Frequency of Breakfast Consumption in Korean Children and Adolescents

Dental caries remains one of the most common chronic diseases affecting children worldwide with a multi-factorial etiology. The objective of the study was to evaluate the association between socioeconomic status (SES), dietary intake, food insecurity (FI), and dental caries in Korean children and adolescents. The study utilized data from the 2-year Korean National Health and Nutrition Examination Survey (KNHANES) conducted with 1,559 Korean boys and 1,391 girls aged 2 to 18 years from 2012 to 2013. Fathers' education (P=0.017), mothers' education (P<0.001), and household income (P=0.049) were all significantly associated with dental caries among Korean boys. As for dietary practices, both eating breakfast (P<0.001) and frequency of eating out (P<0.001) were strongly associated with dental caries (P<0.001). Three models of FI were used and no differences were found regarding genders. In model 3, both food insecure male [odds ratio (OR)=1.682, 95% confidence interval (CI): 0.999~2.832] and female (OR=1.900, 95% CI: 1.094~3.299) subjects had higher odds of developing dental caries than food secure subjects after adjusting the confounding factors. The present study showed a strong association between FI mediated by SES and dental caries. Nutrition education programs targeting low-socioeconomic families are necessary as a tool to prevent dental caries in Korea.

Food Security and Unmet Dental Care Needs in Adults in the United States

Purpose: Low food security is potentially related to poor dental health and unmet dental care needs. Food security has become a significant public health concern in the United States (U.S.) since the Great Recession beginning in 2007. The purpose of this study is to determine the association between low food security and unmet dental care need in adults in the U.S.Methods: A cross-sectional design with data from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 was used for the study to measure unmet dental care need. The study population included 4,845 adults, ages 20 years and above. Chi square tests and logistic regressions were conducted for the statistical analysis.Results: Overall, 47% of participants had unmet dental care need and 16% were found to have low food security. A higher percentage of adults with low food security had unmet dental care need (70.0% vs. 41.0%; p < .000) as compared to adults with full food security. In adjusted analysis, adults with low food security were more likely to have unmet dental care need as compared to participants with full food security (Adjusted Odds Ratio, 1.58 [95% CI: 1.18, 2.12; p <.01]).Conclusions: A significant association between low food security and unmet dental care need was identified among adults in the United States. Dental professionals routinely provide community educational programs and regularly query patients about food intake due to its impact on oral and overall health. It is important for dental professionals to be able to discuss community food resource options or refer patients to social service providers to assist individuals with low food security.

Family Environment and Childhood Obesity: A New Framework with Structural Equation Modeling

The main purpose of the current article is to introduce a framework of the complexity of childhood obesity based on the family environment. A conceptual model that quantifies the relationships and interactions among parental socioeconomic status, family food security level, child’s food intake and certain aspects of parental feeding behaviour is presented using the structural equation modeling (SEM) concept. Structural models are analysed in terms of the direct and indirect connections among latent and measurement variables that lead to the child weight indicator. To illustrate the accuracy, fit, reliability and validity of the introduced framework, real data collected from 630 families from Urumqi (Xinjiang, China) were considered. The framework includes two categories of data comprising the normal body mass index (BMI) range and obesity data. The comparison analysis between two models provides some evidence that in obesity modeling, obesity data must be extracted from the dataset and analysis must be done separately from the normal BMI range. This study may be helpful for researchers interested in childhood obesity modeling based on family environment.