Anthropometric Measures and Early Childhood Caries: A Thai Birth Cohort Study

OBJECTIVES: To investigate the associations between nutritional status and early childhood caries (ECC) in a Thai population, hypothesizing that nutritional extremes, including undernutrition and overnutrition, are associated with increased ECC risk. METHODS: Data from a birth cohort study of Thai children in Khon Kaen were analyzed. Nutritional status at 2 y of age was assessed using anthropometric measurements (height-for-age, weight-for-age, weight-for-height, and body mass index-for-age [BMI-for-age]) categorized by Z-scores adjusted for age and sex. Dental caries was assessed at ages 3 to 4 y using World Health Organization criteria, with ECC defined by the presence of cavitated lesions. Modified Poisson and negative binomial regression analyses with robust variance estimated relative risks (RRs) and 95% confidence intervals (CIs) for ECC prevalence and dmft scores, adjusting for maternal education, breastfeeding duration, sweet consumption frequency, and visible plaque. RESULTS: Among 549 children, overweight/obese children (n = 27) exhibited a significantly lower prevalence of ECC compared with those with normal weight (n = 471) or wasting (n = 50; 59.3% versus 89% and 94%, respectively; P < 0.001). The adjusted RR for overweight/obesity was 0.66 (95% CI: 0.48-0.92) compared with normal weight and 0.64 (95% CI: 0.46 -0.90) compared with wasting. Children with normal weight and those with wasting had comparable ECC prevalence rates (P = 0.50). Similar trends were observed for dmft scores, with overweight/obese children having significantly lower scores compared with those with normal weight or wasting (4.3 versus 7.3 and 8.0, respectively; P = 0.004). Height-for-age and weight-for-age were not significantly associated with ECC, while BMI-for-age yielded results consistent with those for weight-for-height. CONCLUSION: This study reveals an unexpected inverse relationship between overweight status and ECC, suggesting a more complex interplay between nutrition and caries risk. These findings underscore the need for further research into the mechanisms underlying this relationship to inform ECC prevention strategies.Knowledge Transfer Statement:Our findings challenge the hypothesis that all nutritional extremes increase caries risk, revealing an unexpected protective effect of being overweight. This highlights the complex nutrition-caries relationship and the need for context-specific evidence. Further research into the mechanisms behind this surprising link is essential to develop effective and targeted preventive strategies, rather than assuming all nutritional improvements are beneficial for dental health.