December 2006

Patrícia Vasconcelos Leitão Moreira1, Aronita Rosenblatt2 and Aquilina Maria Ribeiro Severo2 Objective: To measure the association between dental caries and obesity in adolescents aged 12 to 15 years attending state and private schools. Basic research design: Cross-sectional study. Research setting: State and private schools in the state of Paraíba, Brazil. Participants: 1,665 obese and 1,665 normal-weight adolescents. Main outcome measures: These were chosen by means of an anthropometric study using height/age and weight/height indices, adopting as baseline the National Center for Health Statistics indices. The diagnostic criteria for caries were those of the World Health Organization (1997). Results: The average DMFT for obese adolescents from state schools was 4.27 and for those of normal weight it was 4.25 (p = 0.7802). In private schools, the corresponding figures were 1.90 and 1.91, respectively (p = 0.1151). In state schools, the caries prevalence amongst the obese group was 50.9% and amongst those of normal weight, 52.4% {p = 0.5393). In private schools, it was 9.0% amongst the obese group and 9.6% amongst those of normal weight {p = 0.6790). Conclusions: There was no statistically significant association between dental caries and obesity. Caries levels were higher amongst adolescents attending state schools. Key words: dental caries, obesity, prevalence Introduction Obesity amongst adolescents is a public health problem of increasing importance in the developed world and in populations undergoing cultural transition (SchonfeldWarden and Warden, 1997). The precise cause of pediatric obesity has not yet been elucidated, although it is suspected that there is a complex interaction of genetic, environmental and behavioural factors. Overweight in adolescence is a predictor of adult obesity, which is associated with several chronic diseases, including type 2 diabetes mellitus, coronary heart disease and hypertension (Hanley et al., 2000). To date the adolescent Brazilian population has not been evaluated in relation to obesity trends. However, adolescence is a critical period for aggravation of preexisting obesity, due to the physiological increase in adipose tissue, increased consumption of high caloric fast food and frequent emotional instabilities (Nguyen et al., 1996). Diet is a deeply ingrained element of a person’s life. It is a cultural trait that reflects factors such as: ethnic background, life-style, values, habits and beliefs. In addition, food is eaten not only for nourishment, but also as a source of pleasure (Katz, 1981). A number of studies have shown a close relationship between a cariogenic diet and the occurrence of dental caries (Duggal et al., 2001; Rodrigues and Sheiham, 2000;). In accordance with the Committee on Medical Aspects of Food Policy, caries experience is positively related to the amount of non-milk extrinsic sugars in the diet and their consumption frequency. Diets with a high sugar intake may contribute to the general excess of food energy consumption responsible for the development of obesity (COMA, 1990). The WHO TRS 916 report (2003) states that nutrition should be placed at the forefront of public health policies and programmes because foods containing high sugar energy contribute to obesity and dental diseases. Therefore, the aim of this study was to measure the association between dental caries and obesity in 12 to 15 years-old adolescents attending state and private schools in the state of Paraíba, Brazil. Method Subjects The population studied comprised adolescents aged from 12 to 15 years of age. A pilot study was carried out to obtain an estimate of dental caries prevalence in obese and normal-weight individuals, and to determine the size of the sample required. A total of 3,330 adolescents, of whom 1,665 were normal weight and 1,665 obese, were selected. The study was carried out in seven state schools and six private schools, selected by a random sampling technique. The selection of students was carried out in two stages. Initially, all the adolescents between 12 and 15 years of age registered at each school were weighed and measured. A total of 4,676 pupils were from state schools and 3,817 from private schools. The prevalence of normal-weight adolescents in state schools was 44%; in private schools, it was 40%. The prevalence of obese pupils was 17.8% in state schools and 21.7% in private schools The second stage comprised the dental examina- Correspondence to: Dr. Patrícia Vasconcelos Leitão Moreira, Sebastião de Azevedo Bastos, n. 40 (202 – A) Manaíra, João Pessoa, Paraíba, 58038-490, Brazil. Email: [email protected]