Sedentary behavior, unhealthy food consumption and dental caries in 12-year-old schoolchildren: a population-based study

Bomfim, Rafael Aiello; Frias, Antonio Carlos; Cascaes, Andreia Morales; Mazzilli, Luiz Eugênio Nigro; Souza, Luciana Bronzi de; Carrer, Fernanda Campos de Almeida; Araújo, Maria Ercília de

doi:10.1590/1807-3107bor-2021.vol35.0041

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Original Research, Social/Community Dentistry • Braz. oral. res. 35 • 2021 • https://doi.org/10.1590/1807-3107bor-2021.vol35.0041 copy

Sedentary behavior, unhealthy food consumption and dental caries in 12-year-old schoolchildren: a population-based study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

This study analyzed the association between sedentary behavior (SB), unhealthy food consumption, and dental caries amongst 12-year-old schoolchildren. An epidemiological survey was carried out in the five largest cities (> 80,000 inhabitants) of the State of Mato Grosso do Sul, Brazil. Data were collected on decayed, missing and filled teeth index (DMFT), sociodemographic characteristics, SB, unhealthy food consumption, and water fluoridation status. The analysis was based on the theoretical framework established by J Sisson. Structural equation models were performed to test the association of dental caries experience with sociodemographic, contextual, and behavioral factors. The mean DMFT index in the five cities was 1.02 (95%CI: 0.39–1.66). Higher sedentary behavior (more than 2 hours/day) [standardized coefficient (SC) = 0.21 95%CI: 0.07–0.39] and higher unhealthy food consumption (more than 4 times/week) [SC = 0.23 (0.10–0.45)] were associated with higher DMFT index than their counterparts. Also, cities with fluoridated water were associated with lower DMFT index [SC = −0.85 (-1.20–-0.50)]. Families who had a per capita income above the poverty line had a direct association with unhealthy food consumption [SC = −0.24 (-0.38–-0.11)]. Unhealthy food consumption mediated the association of sedentary behavior on DMFT index [SC=0.07 (0.02–0.13)]. Sensitivity analysis confirmed the findings. Sedentary behavior mediated by unhealthy food consumption had a significant association with dental caries experience. Public policies must address transdisciplinary actions to reduce sedentary behavior and unhealthy food consumption and promote water fluoridation.

Keywords:
Dental Caries; Sedentary Behavior; Epidemiology; Diet, Food, and Nutrition

Individual variables		n = 615	% (95%CI)	Caries free (DMFT=0)	DMFT
Individual variables		n = 615	% (95%CI)	% (95%CI)	mean (95%CI)
Ethnic group
	Whites	270	43.9(40.0–47.9)	66.0 (46.5–81.3)	0.85 (0.43–1.25)
	Brown	266	43.3(39.4–47.2)	55.6 (40.9–69.4)	1.29 (0.39–2.20)
	Asian	24	3.9 (2.6–5.8)	92.3 (22.9–99.7)	0.50 (0.43–1.01)
	Blacks	32	5.3 (3.7–7.3)	37.3 (25.7–50.7)	1.81 (1.54–2.10)
	Indigenous	6	0.9 (0.4–2.1)	50.0 (35.7– 78.4)	0.76 (0.69–0.84)
	Missing	17	2.8(1.7–4.4)	52.9 (40.3–65.4)	1.59 (1.34–1.87)
Sex
	Female	315	51.2 (47.3–55.2)	63.0 (49.5–74.8)	0.96 (0.27–1.65)
	Male	300	48.8(44.8–52.7)	60.1 (36.8–79.5)	1.10 (0.52–1.67)
Per capita Income (equalized)
	Under poverty level (US$ 120.4/month)	216	35.1 (31.4–39.0)	56.3 (24.1–83.9)	1.18 (0.20–2.16)
	Above poverty level	376	61.1 (57.2–64.9)	64.0 (50.7–75.5)	0.97 (0.45–1.50)
	Missing	23	3.7 (2.5–5.3)	60.9 (50.8–71.3)	0.86 (0.73–0.98)
Parents’ schooling
	1 to 4 years	381	62.0 (58.0–65.7)	58.8 (38.2–76.6)	1.05 (0.50–1.60)
	above 4 years	234	38.0 (34.3–42.0)	70.4 (34.5–91.4)	0.96 (0.40–1.57)
Contextual
Fluoridation status
	Yes	411	66.8 (63.0–70.4)	62.7 (53.4–71.2)	0.92 (0.62–1.23)
	No	204	33.2 (29.6–37.0)	47.4 (40.3–54.6)	1.79 (1.35–2.25)
Unhealthy foods comsumption
	Low (up to 2 times/week)	168	27.3(23.9–31.0)	73.1(66.9–78.5)	0.59 (0.31–0.87)
	Moderate (2-4 times/week)	197	32.0(28.5–35.8)	56.0(47.1–64.4)	1.29 (0.82–1.75)
	High (more than 4 times/week)	217	35.3(31.6–39.2)	52.1(35.1–68.6)	1.33(0.61–2.05)
	Missing	33	5.4(3.8–7.5)	14.3 (6.5–45.5)	2.56 (1.16–5.14)
Sedentary behavior (≥2hs per day)
	No	338	55.0 (50.9–58.9)	71.9(54.0–84.7)	0.77 (0.45–1.46)
	Yes (sum of all domains ≥2 hours day)	251	40.8 (35.9–46.5)	47.5(36.3–58.9)	1.42 (1.06–1.77)
	Not reported	26	4.2 (2.9–6.1)	45.5(40.7–50.3)	1.03 (0.87–1.88)
Brushing
	Twice or more per day	318	52.7 (47.7–55.6)	73.6 (40.5–90.1)	0.76 (0.24–1.60)
	Once per day or none	234	38.1 (34.3–42.0)	53.1 (46.2–59.8)	1.40 (1.02–1.77)
	Missing	63	10.2 (8.0–12.9)	55.0 (40.2–68.3)	1.45 (1.23–1.55)
Cities
	Campo Grande	204	33.2 (29.6–37.0)	68.6 (60.2–75.4)	0.79 (0.38–1.19)
	Dourados	76	12.4 (10.0–15.2)	48.7 (41.6–56.4)	1.16 (0.70–1.61)
	Corumbá	131	21.3 (18.2–24.7)	32.1 (28.4–37.1)	1.80 (1.58–2.03)
	Ponta-Porã	68	11.1 (8.8–13.8)	48.5 (40.9–55.7)	1.62 (0.95–2.29)
	Três Lagoas	136	22.0 (19.0–25.6)	47.1 (41.5–53.6)	1.85 (1.31–2.39)

Direct effects		DMFT			DMFT^* * DMFT used in sensitivity analysis (DMFT = 0 and DMFT ≥ 1).
Direct effects		SC	95%CI	p-value	SC	95%CI	p-value
Behavioral
	SB → DMFT	0.21	(0.07–0.39)	0.023	0.08	(0.03–0.12)	0.001
	Unhealthy food → DMFT	0.23	(0.10–0.45)	0.04	0.08	(0.03–0.14)	0.002
	SB→ Unhealthy food	0.24	(0.16–0.32)	< 0.001	0.24	(0.16–0.32)	< 0.001
	Brushing→ DMFT	–0.40	(-0.72–-0.09)	0.012	–0.12	(-0.20–-0.03)	0.004
	Unhealthy food → brushing	–0.17	(-0.22–-0.12)	< 0.001	–0.17	(-0.21–-0.11)	< 0.001
Socio-demografic
	Sex → DMFT	–0.07	(-0.36–0.21)	0.62	–0.02	(-0.09–0.05)	0.54
	Parents’ Schooling → DMFT	–0.59	(-0.93–-0.25)	< 0.001	–0.19	(-0.28–-0.11)	< 0.001
	Income → DMFT	–0.07	(-0.39–0.23)	0.64	–0.02	(-0.10–0.06)	0.63
	Ethnic → DMFT	0.13	(-0.19–0.47)	0.42	0.04	(-0.04–0.12)	0.32
	Income → Unhealthy food	–0.24	(-0.38–-0.11)	0.001	–0.24	(-0.38–-0.11)	0.001
Contextual
	Fluoridation → DMFT	–0.85	(-1.20–-0.50)	< 0.001	–0.20	(-0.29–-0.11)	< 0.001
Indirect effects
Via unhealthy food
	SB→ DMFT	0.07	(0.02–0.13)	0.01	0.02	(0.01–0.03	0.01
	SB→ Brushing	–0.04	(-0.05–-0.02)	< 0.001	–0.04	(-0.05–-0.02)	< 0.001
	Income→ DMFT	–0.08	(-0.14–-0.01)	0.03	–0.03	(-0.04–-0.01)	0.01
Via brushing
	Unhealthy food → DMFT	0.07	(0.01–0.12)	0.01	0.02	(0.01–0.03)	0.01
Total effects
Behavioral
	SB → DMFT	0.29	(0.10–0.46)	0.002	0.10	(0.05–0.14)	< 0.001
	Unhealthy food → DMFT	0.30	(0.09-0.52)	0.006	0.10	(0.05–0.16)	< 0.001
Covariances
	Income ↔ Ethnic	−0.04	(-0.05–-0.02)	0.001	−0.04	(-0.05–-0.02)	0.001
	Parents Schooling ↔ SB	0.05	(0.02–0.10)	0.005	0.05	(0.02–0.10)	0.005
Goodness of fit
	AIC	19140			17442
	BIC	19361			17663
	RMSE	0.06			0.06
	CLI	0.85			0.85
	TLI	0.80			0.80
	Chi2	< 0.05			< 0.05

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[1] Corresponding Author: Rafael Aiello Bomfim, E-mail: aiello.rafael@gmail.com