Diet quality indicators associated with early childhood caries prevalence in children ages 2–5 in the National Health and Nutrition Examination Survey (NHANES)

Background: Early childhood caries (ECC) is an insidious form of dental caries that strikes the primary dentition. Dental caries represents the most common chronic childhood disease, 5X > asthma and 7X> hay fever. Diet quality and eating behaviors contribute to early childhood caries prevalence. Consistencies in associations between multiple diet quality indicators and ECC have not been studied.

Objective: To examine consistencies between dietary quality indicators and ECC prevalence in children ages 2 to 5 years in the National Health and Nutrition Examination Survey (NHANES).

Methods: The Rao-Scott chi-squared test of independence was used to test for associations between ECC prevalence and diet in NHANES III [1988-1994] (n=4119) and NHANES 2001-2002 (n=801) adjusting for complex survey design for mean Food Pyramid Servings, Healthy Eating Index (HEI), Revised Child Diet Quality Index (RC-DQI) and eating behaviors (meal/snack frequency and soda and water consumption). Significance was established at p<0.05. SAS version 9.1.3, service pack 4 was used to perform the analyses.

Results: Diet quality scores, food servings, and eating behaviors that were significantly associated with ECC prevalence in both NHANES III and NHANES 2001-2002 indicated that children with ECC: (1) Consumed significantly greater Food Pyramid Servings of eggs, lean meat from meat, poultry, and fish and total vegetables (including starchy vegetables); significantly less whole grain, total fruit, other fruit and milk; (2) Had significantly lower HEI total, grain, fruit and cholesterol scores; (3) Had significantly lower RC-DQI whole grain and fruit scores; significantly higher excess juice score (indicating lower intake); and (4) ate fewer than 3 meals daily and drank soda compared to those without ECC.

Conclusion: Specific diet components and poorer dietary quality indicators were consistently associated with a greater likelihood of ECC in young children in both NHANES III and NHANES 2001-2002. Nutrition, dental and medical professionals could reduce children's ECC risk by providing guidance to caregivers of young children to improve diet quality, especially promoting whole grains and fruit. This research identifies a need to develop a Diet Quality Index specific for early childhood caries prevention.