title: Association between added sugar intake and dental caries in Yup'ik children using a novel hair biomarker.
abstract: BACKGROUND
  Dental caries (tooth decay) is a significant public health problem in Alaska Native children. Dietary added sugars are considered one of the main risk factors. In this cross-sectional pilot study, we used a validated hair-based biomarker to measure added sugar intake in Alaska Native Yup'ik children ages 6-17 years (N = 51). We hypothesized that added sugar intake would be positively associated with tooth decay.
  
  
  METHODS
  A 66-item parent survey was administered, a hair sample was collected from each child, and a dental exam was conducted. Added sugar intake (grams/day) was measured from hair samples using a linear combination of carbon and nitrogen ratios. We used linear and log-linear regression models with robust standard errors to test our hypothesis that children with higher added sugar intake would have a higher proportion of carious tooth surfaces.
  
  
  RESULTS
  The mean proportion of carious tooth surfaces was 30.8 % (standard deviation: 23.2 %). Hair biomarker-based added sugar intake was associated with absolute (6.4 %; 95 % CI: 1.2 %, 11.6 %; P = .02) and relative increases in the proportion of carious tooth surfaces (24.2 %; 95 % CI: 10.6 %, 39.4 %; P < .01). There were no associations between self-reported measures of sugar-sweetened food and beverage intake and tooth decay.
  
  
  CONCLUSIONS
  Added sugar intake as assessed by hair biomarker was significantly and positively associated with tooth decay in our sample of Yup'ik children. Self-reported dietary measures were not associated tooth decay. Most added sugars were from sugar-sweetened fruit drinks consumed at home. Future dietary interventions aimed at improving the oral health of Alaska Native children should consider use of objective biomarkers to assess and measure changes in home-based added sugar intake, particularly sugar-sweetened fruit drinks.
authors.affiliation: Department of Oral Health Sciences, University of Washington School of Dentistry, Box 357475, Seattle, WA, 98195, USA. dchi@uw.edu.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Chi
authors.affiliation: University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, USA. sehopkins2@alaska.edu.
authors.forename: Scarlett
authors.initials: S
authors.lastname: Hopkins
authors.affiliation: University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, USA. dmobrien@alaska.edu.
authors.forename: Diane
authors.initials: D
authors.lastname: O'Brien
authors.affiliation: Department of Oral Health Sciences, University of Washington School of Dentistry, Box 357475, Seattle, WA, 98195, USA. llman@uw.edu.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Mancl
authors.affiliation: University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, USA. emorr@alaska.edu.
authors.forename: Eliza
authors.initials: E
authors.lastname: Orr
authors.affiliation: Yukon Kuskokwim Health Corporation, Dentistry Department, Bethel, AK, USA. dane_lenaker@ykhc.org.
authors.forename: Dane
authors.initials: D
authors.lastname: Lenaker
mesh_terms: D000293:Adolescent; D001628:Beverages; D015415:Biomarkers / Q000032:analysis; D002648:Child; D003731:Dental Caries / Q000453:epidemiology; D019422:Dietary Sucrose / Q000009:adverse effects; D005260:Female; D006197:Hair / Q000737:chemistry; D006801:Humans; D008297:Male; D000073893:Sugars; D013549:Sweetening Agents
chemical_list: D015415:Biomarkers; D019422:Dietary Sucrose; D000073893:Sugars; D013549:Sweetening Agents