Dietary intake and severe early childhood caries in low-income, young children

J Acad Nutr Diet. 2013 Aug;113(8):1057-61. doi: 10.1016/j.jand.2013.03.014. Epub 2013 May 23.


Evidence suggests that risk for early childhood caries (ECCs), the most common chronic infectious disease in childhood, is increased by specific eating behaviors. To identify whether consumption of added sugars, sugar-sweetened beverages (SSBs), and 100% fruit juice, as well as eating frequency, are associated with severe ECCs, cross-sectional data collected from a sample of low-income, racially diverse children aged 2 to 6 years were used. Four hundred fifty-four children with severe ECCs and 429 caries-free children were recruited in 2004-2008 from three pediatric dental clinics in Columbus, OH; Cincinnati, OH; and Washington, DC. Dietary data were obtained from one parent-completed 24-hour recall and an interviewer-administered food frequency questionnaire (FFQ). Multivariate logistic regression analyses were conducted to assess associations between severe ECCs and dietary variables. On average, children with severe ECCs consumed 3.2-4.8 fl oz more SSBs (24-hour recall=1.80 vs 1.17; P< 0.001; FFQ=0.82 vs 0.39; P<0.001) and reported significantly more daily eating occasions (5.26 vs 4.72; P<0.0001) than caries-free children. After controlling for age, sex, race/ethnicity, maternal education, recruitment site, and family size, children with the highest SSB intake were 2.0 to 4.6 times more likely to have severe ECCs compared with those with the lowest intake, depending on dietary assessment method (24-hour recall odds ratio 2.02, 95% CI 1.33 to 3.06; FFQ odds ratio 4.63, 95% CI 2.86 to 7.49). The relationship between eating frequency and severe ECC status was no longer significant in multivariate analyses. Specific dietary guidance for parents of young children, particularly regarding SSB consumption, could help reduce severe ECC prevalence.

Keywords: Diet; Early childhood caries; Eating frequency; Sugar-sweetened beverages.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Beverages / adverse effects*
  • Beverages / statistics & numerical data
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Dental Caries / epidemiology*
  • Dental Caries / etiology
  • Dental Caries / pathology
  • Diet, Cariogenic / adverse effects*
  • Diet, Cariogenic / statistics & numerical data
  • Dietary Sucrose / administration & dosage*
  • Dietary Sucrose / adverse effects
  • Eating*
  • Feeding Behavior
  • Female
  • Food Preferences
  • Humans
  • Male
  • Multivariate Analysis
  • Nutrition Assessment
  • Odds Ratio
  • Severity of Illness Index
  • Socioeconomic Factors


  • Dietary Sucrose