Investigation
Nutrition
The association between food insecurity, diet quality, and untreated caries among US children

https://doi.org/10.1016/j.adaj.2021.03.024Get rights and content

Abstract

Background

The aim of this study was to examine the association between food insecurity and untreated caries among US children and the potential role of diet quality as a mediator in this relationship.

Methods

The authors analyzed data for 4,822 children aged 5 through 17 years from the National Health and Nutrition Examination Survey cycles from 2011 through 2014. The authors measured food security as household-level food security status (full, marginal, low, very low) and overall food security status (full food secure, food insecure). They measured diet quality using the Healthy Eating Index. The primary outcome measure was untreated caries (none, ≥ 1). The authors used multiple logistic regression analysis to evaluate the relationships among food insecurity, diet quality, and untreated caries. They conducted mediation analysis using the Baron and Kenny approach.

Results

Food-insecure children were more likely to have untreated caries compared with their fully food-secure counterparts, after controlling for confounding variables (odds ratio [OR], 1.38; 95% [CI, 1.11 to 1.72). Specifically, children from marginal and very low food-secure households had significantly higher odds of untreated caries (OR, 1.48; 95% CI, 1.10 to 2.01) compared with children from fully food-secure households (OR, 1.59; 95% CI, 1.12 to 2.26). Diet quality was not significantly associated with untreated caries.

Conclusions

Food insecurity was negatively associated with untreated caries among US children. Diet quality was not associated with untreated caries.

Practical Implications

Social factors such as food insecurity should be taken into consideration when dental clinicians perform caries risk assessment because caries risk is shown to be associated with overall health and dental health.

Section snippets

Methods

We obtained data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011 through 2012 and 2013 through 2014.29 The study population included children aged 5 through 17 years who had complete food security questionnaires, dietary surveys, and dental examinations and had at least 2 teeth.

We controlled for several potential confounding variables, including age (categorized as 5-8 years, 9-11 years, 12-17 years); sex (male, female); race and ethnicity (White, Black, Hispanic,

Sample characteristics

The study sample included 4,822 children aged 5 through 17 years (Table 1). One-half of the children were male (50.82%), and more than one-half were White (53.33%). Approximately 83% of the children were living in families with annual family income of $20,000 or higher and a mean (standard deviation [SD]) household size of 4.5 (0.03) people. Approximately two-thirds of the children (66.23%) were living in fully food-secure families, 12.31% had marginal household-level food security (HFS),

Discussion

Earlier evidence revealed that food-insecure children are more likely to experience adverse health effects.7, 8, 9, 10, 11 Given the growing area of research on the impact of food insecurity on chronic diseases and well-being, the relationship between food insecurity and oral health is still far from clear. Our study confirms the association between food insecurity and untreated caries among US children aged 5 through 17 years using a nationally representative sample. We found that diet quality

Conclusions

Children from food-insecure household had a higher prevalence of untreated caries than children from full food-secure households. Diet quality was not associated with untreated caries. Our finding indicates the necessity of improving and expanding national public interventions to alleviate food insecurity and to ensure access to nutritious food for children.

Dr. Bahanan is an assistant professor, Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, P.O. Box 80209, Jeddah 21589, Saudi Arabia.

References (48)

  • M.M. Braga et al.

    Detection activity assessment and diagnosis of dental caries lesions

    Dent Clin North Am

    (2010)
  • S. Ghai

    Teledentistry during COVID-19 pandemic

    Diabetes Metab Syndr Clin Res Rev

    (2020)
  • E. Fleming et al.

    Prevalence of total and untreated dental caries among youth: United States, 2015-2016

    NCHS Data Brief

    (2018)
  • G. Slade

    Measuring oral health and quality of life

  • H. Colak et al.

    Early childhood caries update: a review of causes, diagnoses, and treatments

    J Nat Sci Biol Med

    (2013)
  • K.L. Boyd et al.

    Childhood sleep-disorder breathing: a dental perspective

  • S. Dharsini et al.

    The effect of severe caries on the quality of life in young children: a cross-sectional study

    Drug Invent Today

    (2020)
  • Rome Declaration on World Food Security

  • R.E. Kleinman et al.

    Hunger in children in the United States: potential behavioral and emotional correlates

    Pediatrics

    (1998)
  • K. Alaimo et al.

    Food insufficiency and American school-aged children’s cognitive, academic, and psychosocial development

    Pediatrics

    (2001)
  • M. Na et al.

    Food insecurity is associated with suboptimal sleep quality among low-income Head Start preschool-aged children

    Curr Dev Nutr

    (2019)
  • M.M.C. Thomas et al.

    Food insecurity and child health

    Pediatrics

    (2019)
  • L.D. Mangini et al.

    Timing of household food insecurity exposures and asthma in a cohort of US school-aged children. BMJ Open

    (2019)
  • S. Lu et al.

    The relationship between food insecurity and symptoms of attention-deficit hyperactivity disorder in children: a summary of the literature

    Nutrients

    (2019)
  • Cited by (7)

    • Food Security Status, WIC Participation, and Early Childhood Caries in a Nationally Representative Sample of Children

      2023, Journal of the Academy of Nutrition and Dietetics
      Citation Excerpt :

      Considering the lack of interaction of WIC participation and household food security with total caries, findings suggest that child experiences of food insecurity could be a more significant contributor to caries development among WIC-eligible nonparticipants. Previous research has shown that food insecurity increases the risk of untreated caries in US adults and youth,19,20,23 possibly due to unmet dental care needs.15 In younger children, the WIC program may reduce disparities in dental care access by conducting dental screenings and providing referrals for dental care.33,34

    View all citing articles on Scopus

    Dr. Bahanan is an assistant professor, Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, P.O. Box 80209, Jeddah 21589, Saudi Arabia.

    Dr. Singhal is an assistant professor, Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA.

    Dr. Zhao is an associate professor, Center of Alcohol and Substance Use Studies, Department of Applied Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ.

    Ms. Scott is an instructor, Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA.

    Dr. Kaye is a professor, Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA.

    Disclosures.The authors have no conflicts of interest to declare.

    View full text