Sugar consumption and early interruption of breastfeeding are risk factors for dental caries in childhood

A study of 800 children shows that the inclusion of sugar in their diet and the early interruption of breastfeeding are the main factors contributing to the development of dental caries at the age of 2. An article with the results has been published in the journal Community dentistry and oral epidemiology.

The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life, followed by solid foods along with continued breastfeeding on demand until age 2 or older. It also advises against giving infants added sugars before the age of 2.

The study was part of a thematic project titled “MINA Study: Maternal and Child Health in Acre: Birth Cohort in the Western Brazilian Amazon,” which follows children born in 2015-16 in Cruzeiro do Sul, state of Acre, Brazil.

“Some previous studies have pointed to a link between prolonged breastfeeding [for 12 months or more] and the occurrence of dental caries, but without properly considering the role of early added sugar consumption by these children. Our study found that the increased caries risk in the context of long-term breastfeeding is related to sugar consumption,” said Marly Augusto Cardoso, principal investigator on the project. Cardoso is a professor at the University of Washington’s School of Public Health (FSP-USP). Sao Paulo).

“The results confirm previous research findings about the role of free sugar in the development of dental caries. Breast milk lactose alone does not cause the problem. Virtually all children surveyed by our study were exposed to free sugar at an early age.” said Jenny Abanto, first author of the paper. The study was conducted during her postdoctoral fellowship at FSP-USP’s Department of Epidemiology. She is currently a professor at the São Leopoldo Mandic Dental School in São Paulo.

Dental caries was found in 22.8% of the 800 children followed. Taken on its own, this percentage means that children who were breastfed for more than 24 months were at higher risk than children who were breastfed for 12 months or less. However, the incidence of dental caries decreased in line with the decreasing sugar consumption in the former.

“We found that breastfeeding for 24 months reduced consumption of ultra-processed foods or foods with added sugars, which acted as a protective factor against dental caries,” Cardoso said.

Information on food consumption was obtained from interviews in which mothers or caregivers described what the infants had eaten in the past 24 hours. The amount of sugar added to various foods and drinks, such as tea, juice, milk and porridge, was also recorded.

Only 2.8% never consumed sugar before their second birthday and 66.7% consumed foods with added sugar more than five times a day. Only 7.6% consumed no added sugars at all in the first year of life.

The frequency of dental caries varied with family income, level of education, and skin color of the mother or caregiver. It was highest for children of black women in low-income families with less education.

Milk tooth

High sugar consumption results in the formation of a cariogenic dental biofilm known as bacterial plaque. Breast milk is modified by dental plaque and contributes to the demineralization of tooth enamel, but the consumption of sugar triggers this process. The frequency of dental plaque exposure to breast milk is probably the most important factor in the increased risk of dental caries seen in breastfed infants older than 12 months.

“Even if the affected teeth are deciduous or deciduous teeth, dietary habits such as consuming large amounts of sugar in childhood tend to become permanent and put them at risk of developing dental caries later in life. Other studies have also It has been shown that having dental caries in childhood usually also means having them in puberty,” says Abanto, who is also a professor at the International University of Catalonia (UIC Barcelona) in Spain.

Feeding habits are rooted in childhood, she added, and the foods babies become accustomed to influence their lifelong preferences. This is another reason to avoid the consumption of sugar in the first 24 months of a baby’s life.

Even 100% fruit juice is currently discouraged in the first 12 months by the WHO, the Brazilian Ministry of Health and the Brazilian Association of Pediatricians. It may not contain added sugar, but the natural sugar in fruit is separated from the fiber when crushed, and this free sugar has similar effects to, say, sucrose from sugar cane. However, WHO guidelines do not discourage the consumption of whole fresh fruits and vegetables by infants.

“The WHO recommends exclusive breastfeeding for the first six months and advocates continuing breastfeeding on demand until age 2, introducing fruits and other solid foods from six months of age. It also advises against the use of added sugars add up to age 2,” Cardoso said.