1
|
Jangda FH, Suominen AL, Lundqvist A, Männistö S, Golkari A, Bernabé E. Is Starch Intake Associated With Periodontal Status? An 11-Year Longitudinal Analysis Among Finnish Adults. J Clin Periodontol 2024. [PMID: 39317387 DOI: 10.1111/jcpe.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 09/02/2024] [Accepted: 09/06/2024] [Indexed: 09/26/2024]
Abstract
AIM To evaluate the association between baseline starch intake (amount and sources) and changes in periodontal status over 11 years in adults. METHODS Adults aged 30-82 years, who participated in the Finnish Health 2000 survey and were re-examined in 2004/2005 and/or 2011 were included in the study. The consumption of total starch and six relevant food groups (potatoes, fried potatoes, roots and tubers, pasta, wholegrains and legumes) over the past year was determined at baseline with a validated food frequency questionnaire. The number of teeth with periodontal pocketing ≥ 4 mm (NTPP) was recorded during clinical examinations in 2000, 2004/2005 and 2011. The association between baseline starch intake and the 11-year change in the NTPP was tested in mixed-effects negative binomial regression models, adjusting for covariates. RESULTS A total of 1369 adults were included in the analysis. The mean NTPP was 4.1 ± 5.6, 6.3 ± 5.6, and 4.8 ± 5.9 in waves 1, 2 and 3, respectively. Baseline starch intake (in g/day or % energy intake) was not associated with changes in the NTPP after adjustment for covariates. In analysis by food groups, the baseline intake of wholegrains was negatively associated with the NTPP at baseline. CONCLUSION This study found no evidence of an association between baseline starch intake and changes in periodontal status. Baseline intake of wholegrains was associated with better periodontal status at baseline.
Collapse
Affiliation(s)
- F H Jangda
- Institute of Dentistry, Queen Mary University of London, London, UK
| | - A L Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Oral Health Teaching Unit, Kuopio University Hospital, Kuopio, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - A Lundqvist
- National Institute for Health and Welfare, Helsinki, Finland
| | - S Männistö
- National Institute for Health and Welfare, Helsinki, Finland
| | - A Golkari
- Institute of Dentistry, Queen Mary University of London, London, UK
| | - E Bernabé
- Institute of Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
2
|
Hasan F, Yuliana LT, Budi HS, Ramasamy R, Ambiya ZI, Ghaisani AM. Prevalence of dental caries among children in Indonesia: A systematic review and meta-analysis of observational studies. Heliyon 2024; 10:e32102. [PMID: 38882367 PMCID: PMC11176858 DOI: 10.1016/j.heliyon.2024.e32102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/13/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024] Open
Abstract
Objective The prevalence of dental caries among children in Indonesia remains unclear. Therefore, we aimed to provide an updated assessment of this prevalence while also investigating the influence of patient characteristics and methodological factors. Design We performed a systematic review and meta-analysis, including searches of PubMed, Cochrane Library, and Embase from inception to August 24, 2023. We included 8840 participants in 27 studies reporting the prevalence of dental caries among Indonesian children. Results The overall prevalence of dental caries was 76 % (95 % confidence interval: 71%-81 %). Studies in which decay-missing-filled teeth (DMFT) criteria were used to diagnose dental caries were significantly more prevalent than studies using non-DMFT criteria (78 % vs. 64 %, P < 0.05). No significant moderators were identified for the study subgroup based on study origin (Jakarta vs. non-Jakarta) or comorbidity status (comorbidity vs. no comorbidity). Owing to incomplete reporting of variables, metaregression analysis could not be conducted for continuous variables, such as age and male percentage. Conclusions The prevalence of dental caries among Indonesian children remains notably high, showing consistency across Jakarta-based studies and non-Jakarta studies. Initiating dental caries prevention and health promotion campaigns is imperative, focusing on the critical importance of early detection.
Collapse
Affiliation(s)
- Faizul Hasan
- Faculty of Nursing, Chulalongkorn University, Bangkok, 10330, Thailand
| | | | - Hendrik Setia Budi
- Department of Oral Biology, Dental Pharmacology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| | - Rajesh Ramasamy
- Immunology Unit, Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, 43400, Malaysia
| | - Zilzala Irqon Ambiya
- Department of Oral Biology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| | - Anindya Marsa Ghaisani
- Department of Oral Biology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132, Indonesia
| |
Collapse
|
3
|
Ajeeb TT, Gonzalez E, Solomons NW, Vossenaar M, Koski KG. Human milk microbiome: associations with maternal diet and infant growth. Front Nutr 2024; 11:1341777. [PMID: 38529196 PMCID: PMC10962684 DOI: 10.3389/fnut.2024.1341777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Ingestion of human milk (HM) is identified as a significant factor associated with early infant gut microbial colonization, which has been associated with infant health and development. Maternal diet has been associated with the HM microbiome (HMM). However, a few studies have explored the associations among maternal diet, HMM, and infant growth during the first 6 months of lactation. Methods For this cross-sectional study, Mam-Mayan mother-infant dyads (n = 64) were recruited from 8 rural communities in the Western Highlands of Guatemala at two stages of lactation: early (6-46 days postpartum, n = 29) or late (109-184 days postpartum, n = 35). Recruited mothers had vaginally delivered singleton births, had no subclinical mastitis or antibiotic treatments, and breastfed their infants. Data collected at both stages of lactation included two 24-h recalls, milk samples, and infant growth status indicators: head-circumference-for-age-z-score (HCAZ), length-for-age-z-score (LAZ), and weight-for-age-z-score (WAZ). Infants were divided into subgroups: normal weight (WAZ ≥ -1SD) and mildly underweight (WAZ < -1SD), non-stunted (LAZ ≥ -1.5SD) and mildly stunted (LAZ < -1.5SD), and normal head-circumference (HCAZ ≥ -1SD) and smaller head-circumference (HCAZ < -1SD). HMM was identified using 16S rRNA gene sequencing; amplicon analysis was performed with the high-resolution ANCHOR pipeline, and DESeq2 identified the differentially abundant (DA) HMM at the species-level between infant growth groups (FDR < 0.05) in both early and late lactation. Results Using both cluster and univariate analyses, we identified (a) positive correlations between infant growth clusters and maternal dietary clusters, (b) both positive and negative associations among maternal macronutrient and micronutrient intakes with the HMM at the species level and (c) distinct correlations between HMM DA taxa with maternal nutrient intakes and infant z-scores that differed between breast-fed infants experiencing growth faltering and normal growth in early and late lactation. Conclusion Collectively, these findings provide important evidence of the potential influence of maternal diet on the early-life growth of breastfed infants via modulation of the HMM.
Collapse
Affiliation(s)
- Tamara T. Ajeeb
- School of Human Nutrition, McGill University, Montreal, QC, Canada
- Department of Clinical Nutrition, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Emmanuel Gonzalez
- Canadian Centre for Computational Genomics, McGill Genome Centre, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada
| | - Noel W. Solomons
- Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala
| | - Marieke Vossenaar
- Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala
| | | |
Collapse
|
4
|
Esin K, Ballı-Akgöl B, Sözlü S, Kocaadam-Bozkurt B. Association between dental caries and adherence to the Mediterranean diet, dietary intake, and body mass index in children. BMC Oral Health 2024; 24:297. [PMID: 38431554 PMCID: PMC10909275 DOI: 10.1186/s12903-024-04020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Children with healthier nutritional status are less likely to develop severe caries than those with a high-sugar content diet. Studies evaluating dental caries and nutritional status in school-age children have generally focused on dietary intake, diet quality, or anthropometric measures, and the number of studies evaluating them together is limited. OBJECTIVE It was aimed to evaluate the relationship between dental caries adherence to the Mediterranean Diet (MD), dietary intake, and Body Mass Index (BMI) in school-age children. MATERIALS AND METHODS This study was conducted with 300 healthy children (52.0% boys, 48.0% girls) aged between 6 and 12 years. The data collection forms included sociodemographic characteristics, oral health practices of children, Mediterranean Diet Quality Index for children and adolescents (KIDMED), and food consumption records. Anthropometric measurements (body weight and height) of the children were taken. Dental examinations were performed by a pediatric dentist. RESULTS While the DMFT mean score of the children was 1.7 ± 2.09, the mean dft score was 2.9 ± 3.29. The mean of KIDMED scores was 5.9 ± 3.32. DMFT and dft scores decreased statistically as maternal education increased (p < 0.05). DMFT and dft scores were not statistically different between BMI groups according to gender and age (p > 0.05). DMFT scores differed statistically between KIDMED groups (p < 0.05). This difference was between low-optimal and low-improvement-needed groups. While there was a low negative correlation (r=-0.169) between calcium intake and DMFT score, a low positive correlation was found between glucose (r = 0.172) and fructose (r = 0.149) intake and dft score (p < 0.05). In regression analysis, while the children's age related DMFT scores positively, maternal education and KIDMED scores related DMFT scores negatively. Also, children's age and maternal education related dft scores negatively. CONCLUSION In this study, adherence to the MD rather than nutrients was found to be important in dental caries. Also maternal education level was also found to be a determinant factor in dental caries in children. DMFT and dft did not differ between BMI groups.Further studies should be conducted to assess the impact of the MD on dental caries in children to develop dietary interventions for preventative purposes.
Collapse
Affiliation(s)
- Kübra Esin
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Tokat Gaziosmanpaşa University, Tokat, Türkiye.
| | - Beyza Ballı-Akgöl
- School of Dentistry, Department of Pediatric Dentistry, Antalya Bilim University, Antalya, Turkey
| | - Saniye Sözlü
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Tokat Gaziosmanpaşa University, Tokat, Türkiye
| | - Betul Kocaadam-Bozkurt
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Erzurum Technical University, Erzurum, Türkiye.
| |
Collapse
|
5
|
Cao Q, Xiao X, Tao C, Shi R, Lv R, Guo R, Li X, Sui B, Liu X, Liu J. Efficient clearance of periodontitis pathogens by S. gordonii membrane-coated H 2O 2 self-supplied nanocomposites in a "Jenga" style. Biomater Sci 2023; 11:5680-5693. [PMID: 37439322 DOI: 10.1039/d3bm00641g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
As a key pathogen of periodontitis, P. gingivalis requires support of the initial colonizing bacterium (S. gordonii preferably) to form symbiotic biofilms on gingival tissues with enhanced antibiotic resistance. Here, we report a new strategy to treat periodontitis biofilms with S. gordonii membrane-coated H2O2 self-supplied nanocomposites (ZnO2/Fe3O4@MV NPs) in a "Jenga" style. Integration of our special MV coatings enables selectively enhanced internalization of the cargos in S. gordonii, thus inducing severe damage to the foundational bacterial layer and collapse/clearance of symbiotic biofilms consequently. This strategy allows us to clear the symbiotic biofilms of S. gordonii and P. gingivalis with active hydroxyl radicals (˙OH) derived from ZnO2-Fe3O4@MV NPs in a H2O2 self-supplied, nanocatalyst-assisted manner. This "Jenga-style" treatment provides a cutting-edge proof of concept for the removal of otherwise robust symbiotic biofilms of periodontitis where the critical pathogens are difficult to target and have antibiotic resistance.
Collapse
Affiliation(s)
- Qinghua Cao
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Rd, Suzhou 215123, Jiangsu, P. R. China.
| | - Xiang Xiao
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Rd, Suzhou 215123, Jiangsu, P. R. China.
| | - Chengcheng Tao
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Rd, Suzhou 215123, Jiangsu, P. R. China.
| | - Rui Shi
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Rd, Suzhou 215123, Jiangsu, P. R. China.
- University of Groningen and University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Rui Lv
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Rd, Suzhou 215123, Jiangsu, P. R. China.
| | - Ruochen Guo
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Rd, Suzhou 215123, Jiangsu, P. R. China.
| | - Xinyi Li
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Rd, Suzhou 215123, Jiangsu, P. R. China.
| | - Baiyan Sui
- Department of Dental Materials, Shanghai Biomaterials Research & Testing Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, P.R. China
| | - Xin Liu
- Department of Dental Materials, Shanghai Biomaterials Research & Testing Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, P.R. China
| | - Jian Liu
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Rd, Suzhou 215123, Jiangsu, P. R. China.
| |
Collapse
|
6
|
Karkoutly M, Kataish A, Al Kurdi S, Almonakel MB, Bshara N. Knowledge, perceptions, and behavior regarding children's oral health among Syrian pediatricians: a cross-sectional study. BMC Oral Health 2023; 23:272. [PMID: 37165414 PMCID: PMC10170676 DOI: 10.1186/s12903-023-03022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/05/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Oral health has a direct impact on health-related quality of life (HRQoL). Hence, general health and oral health cannot be separated. Pediatricians play a pivotal role in providing primary care for infants and are the first to interact with them since birth. Therefore, the aim of this study was to evaluate the knowledge, perceptions, and behavior of Syrian pediatricians regarding children's oral health. METHODS This was a cross-sectional study. The questionnaire consisted of six main sections and required answers regarding demographic characteristics, knowledge, behavior, perceptions, and training received in oral health. The association between categorical variables was tested with Pearson's chi-square tests and Fishers exact tests using SPSS ver. 23. RESULTS The response rate was 43.12% (229/531). Most of the participants (64.02%) got a poor level of knowledge and no significant association was found between knowledge level and years of experience (p = 0.270). The majority of the participants (99.13%) perceived that diet, bacteria, and sugar exposure time are the etiological factors of dental caries. The overwhelming majority of the participants (98.25%) acknowledged the need for further oral health training during residency. CONCLUSIONS Most pediatricians reported a poor level of knowledge. It is recommended to update the postgraduate and residency curriculum to equip pediatricians with adequate knowledge regarding children's oral health.
Collapse
Affiliation(s)
- Mawia Karkoutly
- Pediatric Dentistry Department, Faculty of Dentistry, Dental College, Damascus University, Damascus, Syrian Arab Republic.
| | - Ammar Kataish
- Department of Pediatrics, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Saleh Al Kurdi
- Pediatric Dentistry Department, Faculty of Dentistry, Dental College, Damascus University, Damascus, Syrian Arab Republic
| | - Mhd Bashier Almonakel
- Pediatric Dentistry Department, Faculty of Dentistry, Dental College, Damascus University, Damascus, Syrian Arab Republic
| | - Nada Bshara
- Pediatric Dentistry Department, Faculty of Dentistry, Dental College, Damascus University, Damascus, Syrian Arab Republic
| |
Collapse
|
7
|
Effectiveness of a Combined Toothbrushing Technique on Cariogenic Dental Biofilm in Relation to Stainless Steel and Elastomeric Ligatures in Orthodontic Patients: A Randomized Clinical Trial. Healthcare (Basel) 2023; 11:healthcare11050731. [PMID: 36900736 PMCID: PMC10000873 DOI: 10.3390/healthcare11050731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Increased dental biofilm commonly occurs during orthodontic treatment. The aim of this study was to evaluate the effect of a combined toothbrushing method on dental biofilm cariogenicity in patients with stainless steel (SSL) and elastomeric (EL) ligatures. At baseline (T1), 70 participants were randomized (1:1 ratio) to the SSL or EL group. Dental biofilm maturity was evaluated using a three-color-disclosing dye. The participants were instructed to brush their teeth using a combined horizontal-Charters-modified Bass technique. Dental biofilm maturity was reassessed at the 4-week follow-up (T2). We found that at T1, new dental biofilm was the highest, followed by mature and cariogenic dental biofilm in the SSL group (p < 0.05). In the EL group, cariogenic dental biofilm was highly observed, followed by mature and new dental biofilm (p < 0.05). After intervention, cariogenic dental biofilm significantly decreased in both groups (p < 0.05). Moreover, a marked decrease in cariogenic dental biofilm was observed in the EL group compared with the SSL group (p < 0.05). However, the change in mature dental biofilm in the groups was similar (p > 0.05). Our results demonstrated that the combined toothbrushing method reduced cariogenic dental biofilm in the SSL and EL groups.
Collapse
|
8
|
Atkinson FS, Cohen M, Lau K, Brand-Miller JC. Glycemic index and insulin index after a standard carbohydrate meal consumed with live kombucha: A randomised, placebo-controlled, crossover trial. Front Nutr 2023; 10:1036717. [PMID: 36875857 PMCID: PMC9982099 DOI: 10.3389/fnut.2023.1036717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/20/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction Kombucha is a complex probiotic beverage made from fermented tea, yet despite extensive historical, anecdotal, and in-vivo evidence for its health benefits, no controlled trials have been published on its effect on humans. Methods We conducted a randomised placebo-controlled, cross-over study that examined the Glycemic Index (GI) and Insulin Index (II) responses after a standardised high-GI meal consumed with three different test beverages (soda water, diet lemonade soft drink and an unpasteurised kombucha) in 11 healthy adults. The study was prospectively registered with the Australian New Zealand Clinical Trials Registry (anzctr.org.au: 12620000460909). Soda water was used as the control beverage. GI or II values were calculated by expressing the 2-h blood glucose or insulin response as a percentage of the response produced by 50 g of glucose dissolved in water. Results There was no statistically significant difference in GI or II between the standard meal consumed with soda water (GI: 86 and II: 85) or diet soft drink (GI: 84 and II: 81, (p = 0.929 for GI and p = 0.374 for II). In contrast, when kombucha was consumed there was a clinically significant reduction in GI and II (GI: 68, p = 0.041 and II: 70, p = 0.041) compared to the meal consumed with soda water. Discussion These results suggest live kombucha can produce reductions in acute postprandial hyperglycemia. Further studies examining the mechanisms and potential therapeutic benefits of kombucha are warranted.
Collapse
Affiliation(s)
- Fiona S Atkinson
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Marc Cohen
- Extreme Wellness Institute, Melbourne, VIC, Australia
| | - Karen Lau
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Jennie C Brand-Miller
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
9
|
Amalia R, Siregar FR, Alfian MF, Arie Sandy LP. Regulations on nutrition in Indonesia and its relation to early childhood caries. Front Public Health 2022; 10:984668. [PMID: 36249209 PMCID: PMC9554401 DOI: 10.3389/fpubh.2022.984668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/07/2022] [Indexed: 01/25/2023] Open
Abstract
There is a close relationship between food and nutrition policies and oral health. The relationship between nutrition and dental problems has been widely discussed, including the major dental problem in children: early childhood caries (ECC). Health-oriented national policies are the main principles of public health welfare. This article is a policy brief that provide a review of the food and nutrition policies in Indonesia that may have a relationship with ECC. It is concluded that some policies support the efforts to prevent ECC however, other technical explanations are still needed for health workers and especially parents regarding its simple implementation in everyday life. Multisectoral approaches that includes health, nutrition and education are needed to address ECC.
Collapse
|