title: Dental caries and childhood obesity: analysis of food intakes, lifestyle.
abstract: OBJECTIVE
  The aims of this cross-sectional statistical study were to evaluate the association between obesity and dental caries and to assess the impact of food intake, oral hygiene and lifestyle on the incidence of dental caries in obese paediatric patients, analysed by Dual X-ray Absorptiometry (DXA).
  
  
  METHODS
  A sample of 96 healthy patients, aged between 6 and 11 years (mean age 8.58±1.43) was classified in relation to body composition assessment and McCarthy growth charts and cut- offs. Body composition analysis, to obtain body fat mass (FM) and body fat free mass (FFM) measurements, was determined by means of a DXA fan beam scanner. The subjects underwent dental examination to assess the dmft/DMFT, and completed a questionnaire on food intake, oral hygiene habits and lifestyle. The sample was subsequently subdivided into four groups: Group A (normal weight - caries-free), Group B (normal weight with caries), Group C (pre-obese/obese - caries-free), Group D (pre-obese/obese with caries).
  
  
  METHODS
  The statistical analysis was performed using SPSS software (version 16; SPSS Inc., Chicago IL, USA). Spearman's correlation was performed to evaluate the correlation between dmft/DMFT and FM%. The chi-square test was performed to assess the categorical variables, while the non-parametric Kruskal Wallis test and the Mann Whitney test were employed for the quantitive variables. Statististical significance was set at a P-value of 0.05.
  
  
  RESULTS
  The preobese-obese children had higher indexes of dental caries than normal weight subjects, both for deciduous teeth (dmft 2.5 ± 0.54 vs 1.4 ± 0.38; p=0.030) and permanent teeth (DMFT 2.8 ± 0.24 vs 1.93 ± 1.79; p=0.039). The correlations between dmft/DMFT indexes and body composition parameters were analysed and a significant correlation between dmft/DMFT indexes and FM% was observed (p=0.031 for dmft, p=0.022 for DMFT). According to the data recorded, there was no statistically significant difference between Groups A, B, C and D in terms of food intake between meals (p=0.436), frequency of starch intake limited to the main meals (p=0.867), home oral hygiene (p=0.905), dental hygiene performed at school (p=0.389), habit of eating after brushing teeth (p=0.196), participation in extracurricular sport activities (p=0.442) and educational level of parents: father (p=0.454), mother (p=0.978). In contrast, there was a statistically significant difference between Groups A, B, C and D in terms of intake of sugar-sweetened drinks (p=0.005), frequency of sugar intake limited to the main meals (p<0.001), frequency of food intake between meals (p=0.038) and sedentary lifestyle (p=0.012). Successive analysis revealed a statistically significant difference between Group A and D in terms of intake of sugar-sweetened drinks (p=0.001), frequency of sugar intake limited to the main meals (p=0.008), and frequency of food intake between meals (p=0.018), and between Group C and D in terms of frequency of sugar intake limited to the main meals (p<0.001), and frequency of food intake between meals (p=0.040).
  
  
  CONCLUSIONS
  This study shows a direct association between dental caries and obesity evident from a correlation between prevalence of dental caries and FM%. The analysis of food intake, dmft/DMFT, FM%, measured by DXA, demonstrates that specific dietary habits (intake of sugar-sweetened drinks, frequency of sugar intake limited to main meals, frequency of food intake between meals) may be considered risk factors that are common to both dental caries and childhood obesity.
authors.affiliation: Paediatric Dentistry, University of Rome Tor Vergata, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Costacurta
authors.affiliation: Paediatric Dentistry, Division of Human Nutrition, University of Rome Tor Vergata, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: DiRenzo
authors.affiliation: Italian National Institute of Statistics (ISTAT).
authors.forename: L
authors.initials: L
authors.lastname: Sicuro
authors.affiliation: Department of Surgery and Medical Science, University of Magna Grecia, Catanzaro, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Gratteri
authors.affiliation: Paediatric Dentistry, Division of Human Nutrition, University of Rome Tor Vergata, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: De Lorenzo
authors.affiliation: Paediatric Dentistry, University of Rome Tor Vergata, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Docimo
mesh_terms: D015502:Absorptiometry, Photon; D001628:Beverages; D001823:Body Composition; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D003430:Cross-Sectional Studies; D004245:DMF Index; D003731:Dental Caries / Q000145:classification*; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D019422:Dietary Sucrose / Q000008:administration & dosage; D004435:Eating; D004522:Educational Status; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D009765:Obesity / Q000145:classification*; D009910:Oral Hygiene; D050177:Overweight / Q000145:classification; D010290:Parents / Q000193:education; D062410:Snacks; D013177:Sports; D014094:Tooth, Deciduous / Q000473:pathology; D014099:Toothbrushing
chemical_list: D004040:Dietary Carbohydrates; D019422:Dietary Sucrose