DOI: 10.1111/ipd.12150
Assessment of the Healthy Eating Index-2005 as a predictor of early childhood caries NADINE A. A. ZAKI, KARIN M. L. DOWIDAR & WAFAA E. E. ABDELAZIZ Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
International Journal of Paediatric Dentistry 2015; 25: 436–443 Background. Early childhood caries (ECC) is a
multifactorial disease resulting mainly from a time-specific interaction of micro-organisms with sugars on a tooth surface. Aim. The purpose of this study was to assess the relationship of dietary intake, as measured by the Healthy Eating Index-2005 (HEI-2005) to ECC. Design. Cross-sectional analytical study. Methods. Sixty preschool children were equally divided into three groups according to their caries experience [Group 1: caries-free children, group 2: children with ECC, group 3: children with severe early childhood caries (S-ECC)]. The decayed (non-cavitated or cavitated), missing (due to
Introduction
Early childhood caries (ECC) is a chronic, infectious disease affecting young children, and constitutes a serious public health problem1. It is defined as the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces (dmfs) in any primary tooth, in a child 71 months of age or younger2. In children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe early childhood caries (S-ECC). From ages 3 through 5, 1 or more dmfs in primary maxillary anterior teeth or a mean dmfs score of ≥4 (age 3), ≥5 (age 4) or ≥6 (age 5) denotes S-ECC3. Like any other form of dental caries, ECC is multifactorial and is mainly attributed to a time-specific interaction of micro-organisms Correspondence to: Nadine A.A. Zaki, Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Alexandria University, Shampoalion Street, Azarita, Alexandria, Egypt. E-mail: [email protected]
436
caries) and filled tooth surfaces (dmfs) score was determined through visual dental examination for each child. Questionnaires were collected recording the demographic characteristics of the families as well as 24-h food recall forms capturing the dietary intake of the children during the previous day. Accordingly, the HEI-2005 score was calculated for each child. Results. The caries experience of the children in this study was significantly associated with their age. Caries-free children showed significantly higher ‘Whole fruit’, ‘Milk’, ‘Sodium’ and total HEI-2005 scores. Conclusions. The study findings illustrate the prominent protective role played by healthful dietary practices against dental caries in preschool children.
with sugars on a tooth surface4. In addition, the influence of social and behavioural risk factors, which are often due to a generally unhealthy lifestyle, has been implicated5. The role of diet in acquisition of the infection and development of the disease is critical6,7. Caries-promoting feeding behaviours result in an increased magnitude of the dental reservoirs of the cariogenic bacteria to pathogenic levels ultimately causing disease6. Among the different foods, dietary sugars, fruit juices and starchy foods have been postulated to possess high cariogenic potential8,9. Apart from those dietary components known for their cariogenic effects, other foods have been investigated for their anticariogenic role, such as milk, cheese, unrefined plant foods, wholegrain foods and finally meat8,10–13. Several instruments have been developed to assess the overall quality of the diet. The Healthy Eating Index-2005 (HEI-2005) is a standardized dietary assessment tool that can be used in nutrition monitoring, interventions and research14. Its twelve components include all of the major food groups found in MyPyramid, namely total fruit, total
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Healthy Eating Index-2005 as a predictor of ECC
vegetables, total grains, milk, as well as meat and beans. Additional components represent whole fruit, dark green and orange vegetables and legumes, whole grains, as well as oils, saturated fat, sodium, and Calories from Solid Fat, Alcohol and Added Sugar (SoFAAS)15. Dietary adequacy is addressed by comparing intake with recommendations. The purpose of this study was to assess the relationship of dietary intake, as measured by the HEI-2005 to ECC. Materials and methods
A cross-sectional, analytical study design was carried out. Sixty healthy children were recruited from the outpatient clinic of the Pediatric Dentistry Department at the Faculty of Dentistry (Dental School), Alexandria University, Egypt. The eligibility criteria included children of both genders; ages ranging from 2 to 6 years (24–71 months), with primary dentition only, of comparable socio-economic status and being residents of Alexandria city. Children with any mental or physical conditions that may affect their oral health status or dietary intake as well as those who were taking any antibiotics 2 weeks before the study were excluded from participation. Based on the diagnostic criteria of ECC and S-ECC reported by the AAPD3, the study sample was further assigned into one of three groups according to their caries experience: Group 1: consisted of 20 caries-free children. Group 2: consisted of 20 children with ECC. Group 3: consisted of 20 children with S-ECC. The authors followed the criteria of Drury et al. for the assessment of non-cavitated lesions as the dmf index usually used to assess caries experience in primary dentition is based on the WHO criteria that only consider caries present on the dentine level (true cavitation). Actually, this is a known limitation of the index and leads to underestimation of the caries experience. Therefore, both criteria were used to ensure accuracy as much as possible in order to fulfil the objectives of the research.
437
Sample size estimation
Sample size was estimated using the following assumptions: type I error = 5%, type II error = 20%, per cent of children using sweet snacks who were caries free = 20%, per cent using sweet snacks with ECC = 60% and with S-ECC = 80%. Based on these assumptions and using MEDCALC (MedCalc software, MariaKerke, Belgium), the minimum required sample size in the group free of caries and ECC group were 20 whereas in the S-ECC group it was calculated to be 7. An equal sample size of 20 per group was used to give a total sample size of 60 children. Ethical considerations
The approval of the research ethics committee of the Faculty of Dentistry, Alexandria University was first sought before the beginning of the study. An informed consent was then obtained from the patients’ caregivers. Furthermore, children presenting with caries or any other oral conditions requiring dental intervention were offered the necessary treatment. Dental examination
After cleaning and drying the teeth, dental examination using sterile dental mirror and proper illumination was conducted to assess the children’s caries experience. When needed, a blunt dental explorer was carefully used without significant axial force or excessive pressure to clean debris from the pits or fissures2. The dmfs score was determined for each child. Non-cavitated carious lesions were diagnosed based on the criteria suggested by Drury et al.2, while cavitated lesions in both pits and fissures as well as on smooth surfaces were recorded according to the World Health Organization (WHO) diagnostic criteria16. Intra-examiner reliability
Prior to the study sample examination, the researcher was calibrated by conducting training sessions with a gold standard to be trained on the proper examination methods, codes and criteria. Intra-examiner reliability was
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
438
N. A. A. Zaki, K. M. L. Dowidar & W. E. E. Abdelaziz
assessed to ensure the consistency of the clinical examination. Results were analysed using Kappa statistics (WHO 1997)16. Study tools
Questionnaire A custom designed questionnaire, based on previous literature review7, was developed in Arabic language, first tested on 10 parents to ensure the clarity of interpretation and then filled out by all the attending children’s parents/caregivers. No modifications were deemed necessary based on the positive feedback of the pilot sample. The questionnaire consisted of three main sections. The first section was concerned with the demographic characteristics of the children including name, age, gender and socio-economic status as indicated by parents’ education and occupation. The second section investigated the feeding pattern of the child whether breast fed or bottle fed, as well as the type of snack whether sweets or juices. The third section included information about the oral hygiene practices of the child such as frequency of tooth brushing and presence of parental supervision, the use of fluoridated toothpaste, and frequency of dental visits. All questionnaire sheets were revised with the parents to ensure completeness and accuracy of the responses. Twenty-four hour dietary recall A 24-h food recall form was designed to capture the preceding 24-h dietary intake of the children15,17. The form was thoroughly explained to both the child, when appropriate, and his/her attending caregiver. After completing the ‘24-h dietary recall’, it was revised with the participants to clarify and complete any necessary details through neutral questions. The dietary intake of each child was then analysed, and the HEI-2005 score was calculated. Healthy Eating Index-2005 • The estimated daily calorie needs of each child were determined according to his/her
gender, age and physical activity level based on the levels suggested by the AAPD18. • Each food item stated in the 24-h dietary recall was transposed into the corresponding components of the HEI-2005.14,15 • Each of the 12 components of the index was assigned the appropriate score according to the HEI-2005 scoring system19 (Fig. 1). • The scores of the 12 components were summed up to obtain the final score of the HEI-2005 for each child, which ranged from 0 to 100. Statistical analysis
Data were tabulated and analysed using the Statistical Package for Social Sciences (SPSS) version 17.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were displayed as means and standard deviation for quantitative variables and frequencies and per cents for qualitative variables. Comparison among the three study groups as regards background variables was conducted using analysis of variance (ANOVA) for comparison of age and Chi-square (v2) for comparison of gender. Kruskal–Wallis test was used to compare the HEI-2005 score categories among the study groups because of the small ordinal scale of some subscores (total fruit, whole fruit, total vegetables, dark green and orange vegetables and legume, total grain and whole grain) and the non-normal distribution of the rest. Statistically, significant differences among the three groups were further investigated using pairwise multiple comparisons with Bonferroni’s adjustment to avoid inflation of type I error. Univariate logistic regression analysis was carried out to assess the effect of total HEI score on each of ECC and S-ECC in two separate models. Bivariate relation between the presence or absence of each of ECC and S-ECC and each component in the HEI score was assessed using Mann–Whitney U-test. Only components with significant effect were entered into multiple logistic regression to identify those significantly affecting two dependent variables in two separate models:
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Healthy Eating Index-2005 as a predictor of ECC
439
Fig. 1. Healthy Eating Index-2005 scoring system.
with or without ECC, and with or without SECC. In this case, the dependent variables were identified as totally caries free (code 0) and have ECC (code 1) or totally caries free (code 0) and have S-ECC (code 1). Per cent of cases correctly classified was calculated in addition to odds ratios and confidence intervals. Significance level was set at 5%. Results
Demographic data The age of the children in the study ranged from 2 to 6 years with a mean of 3.72 1.14 in the caries-free group, 4.65 0.76 in the ECC group and 4.55 0.86 in the S-ECC group showing a statistically significant difference between the three studied groups (P = 0.01) (Table 1). The study sample comprised 53.3% males and 46.7% females with no significant difference in the gender distribution among the three groups (P = 0.28) (Table 1).
Healthy Eating Index-2005 Scores The mean HEI-2005 total score of the cariesfree group accounted for 77.60 5.84, showing a highly statistically significant difference between the three study groups (P < 0.0001) (Table 2). Upon comparing the mean scores of the twelve components of the HEI-2005, only ‘Whole fruit’, ‘Milk’ and ‘Sodium’ showed statistically significant differences among the study groups with P-values of 0.008 for the first component and 0.001 for the two latter ones. The mean scores of the three components were significantly higher among the caries-free group than the ECC and S-ECC groups (Table 2). The logistic regression analysis of the total HEI score showed a significant effect on ECC and S-ECC (P = 0.009 and 0.001, respectively). Meanwhile, slightly greater preventive effect was attributed to HEI in relation to S-ECC compared to ECC where OR accounted for 0.76 and 0.87, respectively (Table 3).
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
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N. A. A. Zaki, K. M. L. Dowidar & W. E. E. Abdelaziz
Table 1. Comparison of the demographic data of the three study groups. N (%) Variables Age* Mean SD Gender Male Female
Caries-free
ECC
S-ECC
4.65 0.76b
3.72 1.14a
13 (65%) 7 (35%)
11 (55%) 9 (45%)
v2 P value
Total
4.55 0.86b
8 (40%) 12 (60%)
4.31 1.01
32 (53.3%) 28 (46.7%)
5.91 0.01† 2.55 0.28
Different letters denoting statistically significant difference. *ANOVA used for comparison instead of v2. †Statistically significant at P ≤ 0.05.
Table 2. Comparison of the HEI-2005 scores among the three study groups. Mean (SD) Caries-free
HEI-2005 scores
ECC
v2 of Kruskal Wallis test P value
S-ECC
Total fruit (5)
3.06 2.16
2.46 2.17
2.73 2.31
Whole fruit (5)
3.19 1.56a
1.33 2.20b
1.40 2.24b
Total vegetables (5)
2.17 1.91
2.81 1.77
2.06 1.54
Green + orange + legume (5)
0.48 1.46
0.44 0.83
00
Total grain (5)
4.32 0.93
4.24 1.20
4.33 1.03
Whole grain (5)
4.08 1.21
2.58 2.45
2.20 2.24
Milk (10)
7.77 1.80a
4.12 3.24b
4.53 3.71b
Meat + bean (10)
8.71 2.10
6.69 3.25
6.13 4.05
Oil (10)
7.55 2.83
7.53 2.22
8.21 2.15
Sat. fat (10)
8.96 2.11
9.50 1.27
8.96 1.45
Sodium (10)
9.04 0.96a
7.80 2.52a
5.42 2.98c
SoFAAS (20)
19.07 1.59
18.57 3.52
17.68 4.21
Total score (100)
77.60 5.84a
68.20 11.43b
63.70 8.23b
1.09 0.58 9.75 0.008* 1.61 0.45 5.57 0.062 0.07 0.96 4.90 0.09 13.64 0.001* 5.40 0.07 0.99 0.61 2.53 0.28 13.68 0.001* 1.74 0.42 20.98
Assessment of the Healthy Eating Index-2005 as a predictor of early childhood caries NADINE A. A. ZAKI, KARIN M. L. DOWIDAR & WAFAA E. E. ABDELAZIZ Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
International Journal of Paediatric Dentistry 2015; 25: 436–443 Background. Early childhood caries (ECC) is a
multifactorial disease resulting mainly from a time-specific interaction of micro-organisms with sugars on a tooth surface. Aim. The purpose of this study was to assess the relationship of dietary intake, as measured by the Healthy Eating Index-2005 (HEI-2005) to ECC. Design. Cross-sectional analytical study. Methods. Sixty preschool children were equally divided into three groups according to their caries experience [Group 1: caries-free children, group 2: children with ECC, group 3: children with severe early childhood caries (S-ECC)]. The decayed (non-cavitated or cavitated), missing (due to
Introduction
Early childhood caries (ECC) is a chronic, infectious disease affecting young children, and constitutes a serious public health problem1. It is defined as the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces (dmfs) in any primary tooth, in a child 71 months of age or younger2. In children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe early childhood caries (S-ECC). From ages 3 through 5, 1 or more dmfs in primary maxillary anterior teeth or a mean dmfs score of ≥4 (age 3), ≥5 (age 4) or ≥6 (age 5) denotes S-ECC3. Like any other form of dental caries, ECC is multifactorial and is mainly attributed to a time-specific interaction of micro-organisms Correspondence to: Nadine A.A. Zaki, Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Alexandria University, Shampoalion Street, Azarita, Alexandria, Egypt. E-mail: [email protected]
436
caries) and filled tooth surfaces (dmfs) score was determined through visual dental examination for each child. Questionnaires were collected recording the demographic characteristics of the families as well as 24-h food recall forms capturing the dietary intake of the children during the previous day. Accordingly, the HEI-2005 score was calculated for each child. Results. The caries experience of the children in this study was significantly associated with their age. Caries-free children showed significantly higher ‘Whole fruit’, ‘Milk’, ‘Sodium’ and total HEI-2005 scores. Conclusions. The study findings illustrate the prominent protective role played by healthful dietary practices against dental caries in preschool children.
with sugars on a tooth surface4. In addition, the influence of social and behavioural risk factors, which are often due to a generally unhealthy lifestyle, has been implicated5. The role of diet in acquisition of the infection and development of the disease is critical6,7. Caries-promoting feeding behaviours result in an increased magnitude of the dental reservoirs of the cariogenic bacteria to pathogenic levels ultimately causing disease6. Among the different foods, dietary sugars, fruit juices and starchy foods have been postulated to possess high cariogenic potential8,9. Apart from those dietary components known for their cariogenic effects, other foods have been investigated for their anticariogenic role, such as milk, cheese, unrefined plant foods, wholegrain foods and finally meat8,10–13. Several instruments have been developed to assess the overall quality of the diet. The Healthy Eating Index-2005 (HEI-2005) is a standardized dietary assessment tool that can be used in nutrition monitoring, interventions and research14. Its twelve components include all of the major food groups found in MyPyramid, namely total fruit, total
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Healthy Eating Index-2005 as a predictor of ECC
vegetables, total grains, milk, as well as meat and beans. Additional components represent whole fruit, dark green and orange vegetables and legumes, whole grains, as well as oils, saturated fat, sodium, and Calories from Solid Fat, Alcohol and Added Sugar (SoFAAS)15. Dietary adequacy is addressed by comparing intake with recommendations. The purpose of this study was to assess the relationship of dietary intake, as measured by the HEI-2005 to ECC. Materials and methods
A cross-sectional, analytical study design was carried out. Sixty healthy children were recruited from the outpatient clinic of the Pediatric Dentistry Department at the Faculty of Dentistry (Dental School), Alexandria University, Egypt. The eligibility criteria included children of both genders; ages ranging from 2 to 6 years (24–71 months), with primary dentition only, of comparable socio-economic status and being residents of Alexandria city. Children with any mental or physical conditions that may affect their oral health status or dietary intake as well as those who were taking any antibiotics 2 weeks before the study were excluded from participation. Based on the diagnostic criteria of ECC and S-ECC reported by the AAPD3, the study sample was further assigned into one of three groups according to their caries experience: Group 1: consisted of 20 caries-free children. Group 2: consisted of 20 children with ECC. Group 3: consisted of 20 children with S-ECC. The authors followed the criteria of Drury et al. for the assessment of non-cavitated lesions as the dmf index usually used to assess caries experience in primary dentition is based on the WHO criteria that only consider caries present on the dentine level (true cavitation). Actually, this is a known limitation of the index and leads to underestimation of the caries experience. Therefore, both criteria were used to ensure accuracy as much as possible in order to fulfil the objectives of the research.
437
Sample size estimation
Sample size was estimated using the following assumptions: type I error = 5%, type II error = 20%, per cent of children using sweet snacks who were caries free = 20%, per cent using sweet snacks with ECC = 60% and with S-ECC = 80%. Based on these assumptions and using MEDCALC (MedCalc software, MariaKerke, Belgium), the minimum required sample size in the group free of caries and ECC group were 20 whereas in the S-ECC group it was calculated to be 7. An equal sample size of 20 per group was used to give a total sample size of 60 children. Ethical considerations
The approval of the research ethics committee of the Faculty of Dentistry, Alexandria University was first sought before the beginning of the study. An informed consent was then obtained from the patients’ caregivers. Furthermore, children presenting with caries or any other oral conditions requiring dental intervention were offered the necessary treatment. Dental examination
After cleaning and drying the teeth, dental examination using sterile dental mirror and proper illumination was conducted to assess the children’s caries experience. When needed, a blunt dental explorer was carefully used without significant axial force or excessive pressure to clean debris from the pits or fissures2. The dmfs score was determined for each child. Non-cavitated carious lesions were diagnosed based on the criteria suggested by Drury et al.2, while cavitated lesions in both pits and fissures as well as on smooth surfaces were recorded according to the World Health Organization (WHO) diagnostic criteria16. Intra-examiner reliability
Prior to the study sample examination, the researcher was calibrated by conducting training sessions with a gold standard to be trained on the proper examination methods, codes and criteria. Intra-examiner reliability was
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
438
N. A. A. Zaki, K. M. L. Dowidar & W. E. E. Abdelaziz
assessed to ensure the consistency of the clinical examination. Results were analysed using Kappa statistics (WHO 1997)16. Study tools
Questionnaire A custom designed questionnaire, based on previous literature review7, was developed in Arabic language, first tested on 10 parents to ensure the clarity of interpretation and then filled out by all the attending children’s parents/caregivers. No modifications were deemed necessary based on the positive feedback of the pilot sample. The questionnaire consisted of three main sections. The first section was concerned with the demographic characteristics of the children including name, age, gender and socio-economic status as indicated by parents’ education and occupation. The second section investigated the feeding pattern of the child whether breast fed or bottle fed, as well as the type of snack whether sweets or juices. The third section included information about the oral hygiene practices of the child such as frequency of tooth brushing and presence of parental supervision, the use of fluoridated toothpaste, and frequency of dental visits. All questionnaire sheets were revised with the parents to ensure completeness and accuracy of the responses. Twenty-four hour dietary recall A 24-h food recall form was designed to capture the preceding 24-h dietary intake of the children15,17. The form was thoroughly explained to both the child, when appropriate, and his/her attending caregiver. After completing the ‘24-h dietary recall’, it was revised with the participants to clarify and complete any necessary details through neutral questions. The dietary intake of each child was then analysed, and the HEI-2005 score was calculated. Healthy Eating Index-2005 • The estimated daily calorie needs of each child were determined according to his/her
gender, age and physical activity level based on the levels suggested by the AAPD18. • Each food item stated in the 24-h dietary recall was transposed into the corresponding components of the HEI-2005.14,15 • Each of the 12 components of the index was assigned the appropriate score according to the HEI-2005 scoring system19 (Fig. 1). • The scores of the 12 components were summed up to obtain the final score of the HEI-2005 for each child, which ranged from 0 to 100. Statistical analysis
Data were tabulated and analysed using the Statistical Package for Social Sciences (SPSS) version 17.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were displayed as means and standard deviation for quantitative variables and frequencies and per cents for qualitative variables. Comparison among the three study groups as regards background variables was conducted using analysis of variance (ANOVA) for comparison of age and Chi-square (v2) for comparison of gender. Kruskal–Wallis test was used to compare the HEI-2005 score categories among the study groups because of the small ordinal scale of some subscores (total fruit, whole fruit, total vegetables, dark green and orange vegetables and legume, total grain and whole grain) and the non-normal distribution of the rest. Statistically, significant differences among the three groups were further investigated using pairwise multiple comparisons with Bonferroni’s adjustment to avoid inflation of type I error. Univariate logistic regression analysis was carried out to assess the effect of total HEI score on each of ECC and S-ECC in two separate models. Bivariate relation between the presence or absence of each of ECC and S-ECC and each component in the HEI score was assessed using Mann–Whitney U-test. Only components with significant effect were entered into multiple logistic regression to identify those significantly affecting two dependent variables in two separate models:
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Healthy Eating Index-2005 as a predictor of ECC
439
Fig. 1. Healthy Eating Index-2005 scoring system.
with or without ECC, and with or without SECC. In this case, the dependent variables were identified as totally caries free (code 0) and have ECC (code 1) or totally caries free (code 0) and have S-ECC (code 1). Per cent of cases correctly classified was calculated in addition to odds ratios and confidence intervals. Significance level was set at 5%. Results
Demographic data The age of the children in the study ranged from 2 to 6 years with a mean of 3.72 1.14 in the caries-free group, 4.65 0.76 in the ECC group and 4.55 0.86 in the S-ECC group showing a statistically significant difference between the three studied groups (P = 0.01) (Table 1). The study sample comprised 53.3% males and 46.7% females with no significant difference in the gender distribution among the three groups (P = 0.28) (Table 1).
Healthy Eating Index-2005 Scores The mean HEI-2005 total score of the cariesfree group accounted for 77.60 5.84, showing a highly statistically significant difference between the three study groups (P < 0.0001) (Table 2). Upon comparing the mean scores of the twelve components of the HEI-2005, only ‘Whole fruit’, ‘Milk’ and ‘Sodium’ showed statistically significant differences among the study groups with P-values of 0.008 for the first component and 0.001 for the two latter ones. The mean scores of the three components were significantly higher among the caries-free group than the ECC and S-ECC groups (Table 2). The logistic regression analysis of the total HEI score showed a significant effect on ECC and S-ECC (P = 0.009 and 0.001, respectively). Meanwhile, slightly greater preventive effect was attributed to HEI in relation to S-ECC compared to ECC where OR accounted for 0.76 and 0.87, respectively (Table 3).
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
440
N. A. A. Zaki, K. M. L. Dowidar & W. E. E. Abdelaziz
Table 1. Comparison of the demographic data of the three study groups. N (%) Variables Age* Mean SD Gender Male Female
Caries-free
ECC
S-ECC
4.65 0.76b
3.72 1.14a
13 (65%) 7 (35%)
11 (55%) 9 (45%)
v2 P value
Total
4.55 0.86b
8 (40%) 12 (60%)
4.31 1.01
32 (53.3%) 28 (46.7%)
5.91 0.01† 2.55 0.28
Different letters denoting statistically significant difference. *ANOVA used for comparison instead of v2. †Statistically significant at P ≤ 0.05.
Table 2. Comparison of the HEI-2005 scores among the three study groups. Mean (SD) Caries-free
HEI-2005 scores
ECC
v2 of Kruskal Wallis test P value
S-ECC
Total fruit (5)
3.06 2.16
2.46 2.17
2.73 2.31
Whole fruit (5)
3.19 1.56a
1.33 2.20b
1.40 2.24b
Total vegetables (5)
2.17 1.91
2.81 1.77
2.06 1.54
Green + orange + legume (5)
0.48 1.46
0.44 0.83
00
Total grain (5)
4.32 0.93
4.24 1.20
4.33 1.03
Whole grain (5)
4.08 1.21
2.58 2.45
2.20 2.24
Milk (10)
7.77 1.80a
4.12 3.24b
4.53 3.71b
Meat + bean (10)
8.71 2.10
6.69 3.25
6.13 4.05
Oil (10)
7.55 2.83
7.53 2.22
8.21 2.15
Sat. fat (10)
8.96 2.11
9.50 1.27
8.96 1.45
Sodium (10)
9.04 0.96a
7.80 2.52a
5.42 2.98c
SoFAAS (20)
19.07 1.59
18.57 3.52
17.68 4.21
Total score (100)
77.60 5.84a
68.20 11.43b
63.70 8.23b
1.09 0.58 9.75 0.008* 1.61 0.45 5.57 0.062 0.07 0.96 4.90 0.09 13.64 0.001* 5.40 0.07 0.99 0.61 2.53 0.28 13.68 0.001* 1.74 0.42 20.98
