Tuesday, August 8, 2017

Early childhood caries and intake of 100 percent fruit juice:
Data from NHANES (National Health and Nutrition Examination Survey), 1999-2004

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Suhyun   Rue                                                         Date: 08/09/2017
Article Title: Early childhood caries and intake of 100 percent fruit juice: Data from NHANES, 1999-2004
Author(s): Clemencia M. Vargas, Bruce A. Dye, Catherine R. Kolasny, Dennis W. Buckman, Timothy S. McNeel, Norman Tinanoff, Teresa A. Marshall and Steven M. Levy
Journal: Journal of the American Dental Association
Date: December 2014
Major Topic: Association Between Early Childhood Caries and 100% Fruit Juice
Type of Article: Retrospective cross-sectional study (prevalence study)
Main Purpose: The results of several studies conducted in the United States show no association between intake of 100 percent fruit juice and ECC. The authors examined this association according to poverty and race/ethnicity among U.S. preschool children.
Key Points: No association between ECC and consumption of 100 percent fruit juice
BACKGROUND:
   -ECC is more likely to affect the most socially vulnerable children: those living in poverty and those from ethnic minority groups, but a recent increase in dental caries prevalence among children younger than 6 years has been seen in traditionally low-risk children, such as those living in higher-income families, is being affected by dental caries
   -NHANES (National Health and Nutrition Examination Survey) data was used in a previous study to determine association between dental caries and consumption of 100 percent fruit juice for children aged 2 -5 years with primary teeth
METHODS:
   -This study used data obtained by NHANES from 1999-2004
   -The study sample consisted of a total of 2,290 children aged 2 through 5 years for whom we had complete dental examination and dietary recall data
   -Analyzed dental caries experience as prevalence (yes or no)
   -Defined consumption as having 100% juice in the last 24 hours
1.       -Analyzed consumption as prevalence (yes or no)
2.       -Also, analyzed consumption in ordinal categories (0 oz vs. 0-6 oz vs. more than 6 oz.)
   -Other variables
1.        -Age
2.        -Gender – male or female
3.        -Race/ethnicity – non-Hispanic white, non-Hispanic black, Mexican-American, others
4.        -Poverty level– less than 1.00 poverty income ratio (PIR), 1.00-2.99 PIR, greater than
             3.00    PIR
5.        -Dental visit in previous 12 months – yes or no
CONCLUSIONS:
   -There is no association between consumption of 100% fruit juice in the previous 24 hours and dental caries among young children in NHANES 1999-2004 
-They found no significant difference in the percentage of children consuming more than 6 oz of 100 percent fruit juice according to poverty level. In addition, there is no significant difference in children’s consumption of  100 percent fruit juice according to gender or race.
     -The results presented in this study should be considered preliminary and indicate the need for further research
o   -The result is somewhat counterintuitive given the understanding of sugars and their role in the dental caries process
  -Factors that could explain the lack of association:
1.       -Ubiquitous fluoride exposure
2.       -Timing and frequency of sugar consumption
3.       -Behavior due to health-consciousness
  -Oral health care providers and educators should recommend limiting consumption of 100 percent fruit juice to 4 to 6 oz per day for children 1 to 5 years of age for its overall health benefit (that is, nutritional value) rather than as a means to prevent caries.
  -The study findings were consistent with those of other studies
Remarks:
1.  -Study does not relay what fruits are being ingested – different fruits affect mineralization processes differently. Also fruits have different sugar types, which also affects demineralization
2.  - Limitations of this study are related to data collection methods and cross-sectional nature of the data
Assessment of Article:  Level II-3 Retrospective cross-sectional study (prevalence study)
This study was funded by an R-03 grant – NIH Small Grant Program


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