Body mass index and dental caries in young people: a systematic review.

BACKGROUND: Obesity and caries in young people are issues of public health concern. Even though research into the relationship between the two conditions has been conducted for many years, to date the results remain equivocal. The aim of this paper was to determine the nature of the relationship between Body Mass Index (BMI) and caries in children and adolescents, by conducting a systematic review of the published literature. METHODS: A systematic search of studies examining the association between BMI and caries in individuals younger than 18 years old was conducted. The electronic bibliographic databases PubMed, MEDLINE, Embase, CINAHL, CENTRAL and Google Scholar were searched. References of included studies were checked to identify further potential studies. Internal and external validity as well as reporting quality were assessed using the validated Methodological Evaluation of Observational Research checklist. Results were stratified based on the risk of flaws in 14 domains 10 of which were considered major and four minor. RESULTS: Of the 4208 initially identified studies, 84 papers met the inclusion criteria and were included in the review; conclusions were mainly drawn from 7 studies at lower risk of flaws. Three main types of association between BMI and caries were found: 26 studies showed a positive relationship, 19 showed a negative association, and 43 found no association between the variables of interest. Some studies showed more than one pattern of association. Assessment of confounders was the domain most commonly found to be flawed, followed by sampling and research specific bias. Among the seven studies which were found to be at lower risk of being flawed, five found no association between BMI and caries and two showed a positive association between these two variables. CONCLUSIONS: Evidence of an association between BMI and caries was inconsistent. Based on the studies with a low risk lower risk of being flawed, a positive association between the variables of interest was found mainly in older children. In younger children, the evidence was equivocal. Longitudinal studies examining the association between different indicators of obesity and caries over the life course will help shed light in their complex relationship.

Obesity and caries in four-to-six year old English children: a cross-sectional study.

BACKGROUND: Obesity and caries are common conditions in childhood and can have significant implications on children's wellbeing. Evidence into their association remains conflicting. Furthermore, studies examining the ssociation between obesity and caries commonly focus on individual-level determinants. The present study aimed to examine the association between obesity and caries in young English children and to determine the impact of deprivation and area-level characteristics on the distribution of the two conditions. METHODS: This was a cross-sectional study among children in Plymouth city aged four-to-six years. Anthropometric measurements included weight and height (converted to Body Mass Index centiles and z-scores), and waist circumference. Caries was assessed by using the sum of the number of teeth that were decayed, missing or filled. A questionnaire was used to obtain information on children's demographic characteristics, oral hygiene, and dietary habits. The impact of deprivation on anthropometric variables and caries was determined using Linear and Poisson regression models, respectively. Multiple logistic regression was used to assess the association between different anthropometric measures and caries. Logistic regression models were also used to examine the impact of several demographic characteristics and health behaviours on the presence of obesity and caries. RESULTS: The total sample included 347 children aged 5.10 ± 0.31 (mean ± SD). Deprivation had a significant impact on caries and BMI z-scores (p < 0.05). Neither BMI- nor waist circumference z-scores were shown to be significantly associated with dental caries. Among the neighbourhood characteristics examined, the percentage of people dependent on benefits was found to have a significant impact on caries rates (p < 0.05). Household's total annual income was inversely related to caries risk and parental educational level affected children's tooth brushing frequency. CONCLUSIONS: No associations between any measure of obesity and caries were found. However, deprivation affected both obesity and caries, thus highlighting the need to prioritise disadvantaged children in future prevention programmes.

Neighbourhood deprivation and excess coronary heart disease mortality and hospital admissions in Plymouth, UK: an ecological study.

BACKGROUND: Among primary coronary heart disease (CHD) risk factors, certain socioeconomic characteristics of individuals and living environments appear to play a central role. The objective of this study was to assess the burden of neighbourhood deprivation-associated excess in mortality and hospital admission from CHD in Plymouth. METHODS: A small area ecological study using indices of neighbourhood deprivation and coronary heart disease mortality and hospital admission data aggregated for 1991-2003 for CHD mortality and for 1997-2004 for CHD hospital admission. Locally defined community areas (n = 43) were classified according to the Townsend index, measuring material deprivation. RESULTS: CHD mortality and hospital admission increased with Townsend deprivation score in all ages and gender groups. The age-adjusted deprivation-associated excess CHD hospital admission was 15.4% in men and 27.9% in women higher for most compared to the least deprived group. The age-adjusted deprivation-associated excess CHD mortality was 31.5% and 18.9% for men and women, respectively. Excess mortality in the 13-year period studied accounted for more than 1380 and 670 deaths for men and women. Excess hospital admissions in the 7-year period studied accounted for more than 966 and 769 hospital admissions for men and women. A larger proportion of excess CHD deaths were found among men while excess CHD hospital admissions were found among women. The most deprived areas showed the highest mortality and hospital admission risk. CONCLUSION: Despite the existence of a system of universal health care, inequalities in CHD mortality and hospital admission persist and need to be taken into account when implementing intervention programmes.