A prospective, four-year longitudinal study of 209 Peruvian children was conducted to evaluate the effect of a single malnutrition episode occurring at infancy (i.e., < 1 year of age) on dental caries in the primary teeth. Children were recruited into the study at age 6-11 months after they had suffered from a malnutrition episode and were thus classified by anthropometry as either: (1) Normal; (2) Wasted (low weight for height); (3) Stunted (low height for age); or (4) Stunted and Wasted (S and W). Eruption of the primary teeth was significantly delayed in all malnourished children; however, the effect of stunting--that is, retarded linear growth--was more pronounced and lasted longer than that of wasting or acute malnutrition (i.e., 2.5 vs. 1.5 years, respectively). By age 4 years, children from group 4 (S and W) showed a significantly higher caries experience in the primary teeth than did those in any of the other three groups. In summary, this longitudinal study has confirmed previous studies in animals and indirect epidemiological evidence which had suggested a cause-effect relationship between early malnutrition and increased dental caries.
PIP: The study was conducted from 1986 through 1990 among 209 children residing in Canto Grande, a poor community located north of Lima, Peru. The children were recruited as infants, aged 6-11 months, from the outpatient population of the Canto Grande Health Center, or from two other hospitals. All children were of full-term gestation and normal birth weight ( 2500 g). Each child was assigned to 1 of 4 study groups ascertained by weight and height measurements, with the National Center for Health Statistics standards used as the reference: 1) normal; 2) wasted, indicating current acute malnutrition; 3) stunted, indicating past or chronic malnutrition; and 4) stunted and wasted, indicating malnutrition soon after birth. The data, composed of 2700 examinations, were analyzed by the Statistical Analysis System (SAS) General Linear Models (GLM) program for computation of ANOVA tables. The mean numbers of teeth at ages 1 and 1.5 years for normal children were significantly higher than those of the children who were either wasted, stunted, or stunted and wasted as infants. At age 2, normal children had significantly more teeth in the mouth than did stunted children and stunted and wasted children. At age 2.5, the number of teeth in the normal children was still significantly higher than in stunted children. At age 4, all 4 groups had their full 20 teeth. At age 4, children who were stunted and wasted during infancy showed a significantly higher number of decayed, extracted, and filled teeth (def) compared with that of the other 3 groups. When grouped into 4 def categories of low, moderate, high, and very high caries experience, the distribution of the 4th group was distinctly different from that of the other 3 groups. 17.2% of stunted and wasted children had a very high caries experience (i.e., def 13) at age 4, significantly higher than that in any of the other 3 groups (i.e., normal 9.8%, wasted 4.4%, and stunted 3.6%, respectively; p 0.001).