Sugar, dental caries and the incidence of acute rheumatic fever: a cohort study of Māori and Pacific children.
To determine whether dental caries, as an indicator of cumulative exposure to sugar, is associated with the incidence of acute rheumatic fever and chronic rheumatic heart disease, in Māori and Pacific children aged 5 and 6 years at their first dental visit.



A cohort study was undertaken which linked school dental service records of caries with national hospital discharge and mortality records. Cox models were used to investigate the strength of the association between dental caries and rheumatic fever incidence.



A total of 20 333 children who were free of rheumatic heart disease at enrolment were available for analysis. During a mean follow-up time of 5 years, 96 children developed acute rheumatic fever or chronic rheumatic heart disease. After adjustment for potential confounders, children with five or more primary teeth affected by caries were 57% (95% CI: 20% to 106%) more likely to develop disease during follow-up, compared to children whose primary teeth were caries free. The population attributable to the risk for caries in this cohort was 22%.



Dental caries is positively associated with the incidence of acute rheumatic fever and chronic rheumatic heart disease in Māori and Pacific children. Sugar intake, an important risk factor for dental caries, is also likely to influence the aetiology of rheumatic fever.
Auckland Regional Public Health Service, Auckland, New Zealand.
Simon
S
Thornley
Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand.
Roger J
RJ
Marshall
Paediatric Services, Oral Health Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand.
Katie
K
Bach
Paediatric Services, Oral Health Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand.
Pauline
P
Koopu
Auckland Regional Public Health Service, Auckland, New Zealand.
Gary
G
Reynolds
Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand.
Gerhard
G
Sundborn
Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand.
Win Le Shwe Sin
WL
Ei
D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002669:Child Welfare / Q000706:statistics & numerical data; D015331:Cohort Studies; D003731:Dental Caries / Q000150:complications / Q000175:diagnosis*; D019422:Dietary Sucrose / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015596:Nutrition Assessment; D012213:Rheumatic Fever / Q000175:diagnosis* / Q000209:etiology; D012307:Risk Factors
D019422:Dietary Sucrose
Cohort studies; DENTAL HEALTH; DIET; EPIDEMIOLOGY; RHEUMATIC DISEASES