|Year : 2014 | Volume
| Issue : 4 | Page : 150-154
Is body mass index truly related to dental caries? Survey on predisposing factors for overweight among Indian school children
Md Zabirunnisa Begum1, Myla Nagamalleshwari2, Pachava Srinivas3, Jayaprakash S Gadagi4, Praveen Gadde1, Koneru Jyothirmai5
1 Department of Public Health Dentistry, Vishnu Dental College, Bhimavaram, India
2 Department of Orthodontics, Vishnu Dental College, Bhimavaram, India
3 Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Guntur, India
4 Department of Periodontics, Vishnu Dental College, Bhimavaram, India
5 Department of Oral Medicine Vishnu Dental College, Bhimavaram, India
|Date of Web Publication||12-Sep-2014|
Dr. Md Zabirunnisa Begum
Department of Public Health Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh - 534 202
Source of Support: None, Conflict of Interest: None
Introduction: Globally, non-communicable diseases are increasingly recognized as a major cause of morbidity and mortality. Among them, overweight and obesity are imperative. The problem of overweight and obesity is not confined to adults but also to children and adolescents. The present changing dietary pattern among children is contributing to childhood overweight and on other hand stands as a risk factor in the development of dental caries, hence the study aimed to investigate the relation between overweight and dental caries among school children. Materials and Methods: A cross-sectional study was conducted among 5-6-year and 12-year-old school children to evaluate the relation between body mass index (BMI) and dental caries. Using stratified random sampling technique 1017 school children were selected. Subjects who have brought consent from their parents were included and subjects who were absent on the day of examination were excluded. A pre-structured questionnaire was prepared to collect data regarding demographic details, oral hygiene practices, dentition status and treatment needs, (BMI), 24-hour diet history, physical activity, and television watching. The data collected were subjected to statistical analysis (SPSS V 16.0) using Chi-square and multivariate logistic regression tests. Results: "Risk of overweight" 20% and an "overweight" of 40% were observed. With BMI, parental overweight (P = 0.001), socioeconomic status (SES) (P = 0.001), physical activity (P = 0.001) and television watching (P = 0.001) were found to be statistically related. Body mass index and dental caries were not statistically related. Conclusion: These complex and multifactorial relations like overweight and dental caries may involve many unknown factors which warrant exploration on larger population.
Keywords: Body mass index, dental caries, overweight, parental obesity, school children
|How to cite this article:|
Begum M, Nagamalleshwari M, Srinivas P, Gadagi JS, Gadde P, Jyothirmai K. Is body mass index truly related to dental caries? Survey on predisposing factors for overweight among Indian school children. Dent Hypotheses 2014;5:150-4
|How to cite this URL:|
Begum M, Nagamalleshwari M, Srinivas P, Gadagi JS, Gadde P, Jyothirmai K. Is body mass index truly related to dental caries? Survey on predisposing factors for overweight among Indian school children. Dent Hypotheses [serial online] 2014 [cited 2020 Jul 16];5:150-4. Available from: http://www.dentalhypotheses.com/text.asp?2014/5/4/150/140605
| Introduction|| |
Globally, non-communicable diseases are increasingly recognized as a major cause of morbidity and mortality. The increasing burden of non-communicable diseases, particularly in developing countries of Asia including India, threatens to overwhelm already stretched health services.  Among them, overweight and obesity are the most important. Prevalence of overweight and obesity from 2006 to 2009 in urban Asian Indians shows a prevalence of 11% due to changing lifestyles and diet.  The problem of overweight and obesity is confined not only to adults but also to children and adolescents. Various studies also indicate that the prevalence of overweight and obesity among children of all ages is increasing in developing countries. ,,
The rising prevalence of childhood/adolescent overweight and obesity cannot be addressed by a single etiology. Multiple factors plays role i.e., lack of physical activity, unhealthy eating patterns, or a combination of both with genetics and lifestyle playing important roles in determining a child's weight. The popularity of 'fast food', junk food, sedentary lifestyles, increased 'pocket money', lack of sports, increased television watching, computer usage, and working parents have all led to a change in the way of life. This 'nutritional transition' and the lifestyle changes are becoming relevant among school children. India is also passing through such a transitional phase of socio-economic development which has the potential of altering the nutritional status of her population groups. ,
Current researches in dental sciences trends toward exploring the link between oral health and systemic health.  The present changing dietary pattern among children is contributing to childhood overweight and on other hand stands as a risk factor in the development of dental caries, this relation between childhood overweight and dental caries is biologically plausible.  Hence, the present study was aimed to explore the risk factors for dental caries among overweight Indian children.
| Materials and Methods|| |
A cross-sectional study was conducted among 5-6-year and 12-year-old school children of Guntur city. Institutional ethical clearance, Permission from District Education Office and respective school authorities were obtained prior to the start of study. Also, informed consent form was signed by all subjects.
Stratified random sampling technique was used to stratify all schools in Guntur city into Government and Private aided and Private unaided schools. From each stratum, 5 schools were randomly selected to gather estimated sample. Sample size was calculated based on prevalence of overweight and obesity.  The estimated sample size was 1017. A consent form was prepared along with study details to gather information on: parents' education, occupation, family income per month, father's height, weight, mother's height, and weight. A pre-structured Study Proforma was prepared to collect data regarding demographic information: name, age, gender, type of school, studying class. ADA specified - TYPE III Clinical examination was done with a plane mouth mirror and CPI probe in natural day light to record DMFT index. Weight and height of the children were recorded with the help of weighing machine corrected for zero error and with least measurement up to 0.5 kg and height recorded with measuring tape with least measurement of 1 cm. Body mass index (BMI) was calculated by dividing weight in kilograms divided by square of height in meters. 
The calculated BMI value for school children was converted to percentiles according to growth monitoring guidelines.  The BMI for parents was also calculated and categorized.  Socioeconomic status (SES) of study subjects was classified.  From 24-hour recall diet history children according to their diet frequency including in- between snacks per day were categorized into low caries risk whose frequency is <6 times/day and into moderate caries risk whose frequency is >6 times /day.  Television watching/ computer usage ≥16 hr/week  and minimum physical activity or at least 60 minutes/day were also recorded. 
A pilot study was conducted on 30 subjects to know the feasibility, accessibility of the study. Intra-examiner validity was checked on a group of 20 subjects for two consecutive days (N = 10 each day) and acceptable consistency achieved was in the range of 85-90%. A set of 20 instruments were autoclaved every day before they were carried to the site of examination. Each day 15-20 students were examined. Each student's dental treatments needs were noted in their school dairy and told to show their parents and get the advised treatments done. After completion of dental examination in each school, health talk was given using audio-visual aids as well as chalk and board to all the students in the school.
Data collected was compiled using Microsoft Excel software 2007 and analyzed using SPSS V: 15.0 and statistical analysis was done by using the following statistical tests: Chi-square test (χ2 ) to compare the categorized data; Odd ratio (OR) to know the association between BMI and dental caries; Logistic regression model analysis for predicting risk variables associated with overweight/risk for overweight.
| Results|| |
Out of 1017 subjects, 428 subjects (42%) were in 5-6-year age group and 589 subjects (58%) were in 12-year age group. According to gender distribution of subjects, 48.3% were males and 51.7% were females.
In our study 20% of subjects were at 'Risk of overweight' [85th to < 95th percentile] and 40% were in 'Overweight' [≥ 95 th percentile]. Among 5-6-year subjects the prevalence of overweight among females and males were 62.8% and 68.8%, respectively. In 12-year-old subjects 15% of females and 20.4% of males were overweight this observation was highly statistically significant [Table 1]. As observed there was a higher incidence of overweight among boys (42.4%) than in girls (38%) and more percent of overweight children are from private schools.
Dental caries prevalence was 62.5% with a mean DMFT score of 1.25 ± 1.38 in 12-year-old children and 29.4% with a deft score of 1.05 ± 1.95 among 5-6-year-old children. Caries experience and BMI Status did not show statistical significant relation with both age groups (P = 0.199) [Table 2] and [Table 3].
|Table 2: Relationship between BMI Status and caries experience of 5-6-year-old children (n = 428)|
Click here to view
|Table 3: Relationship between BMI Status and caries experience of 12-year-old group children (n = 589)|
Click here to view
Statistical significance was observed between BMI status and SES [Table 4]. Television watching and physical activity were also significantly (P = 0.001) related to BMI. Overall BMI status and caries risk were not significantly (P =0.293) related. Relationship between caries experience and caries risk was found to be not significant (P = 0.157). Statistically significant positive correlation coefficient was observed between Parental BMI and child BMI status.
Multivariate logistic regression analysis showed that television watching (P = 0.001; OR = 3.21; CI =1.95-5.31), Parental obesity (P = 0.002; OR=1.60; CI=1.18-2.16) and physical activity (P = 0.339; OR =1.40; CI = 0.92-2.14) were found to have considerable risk for childhood overweight [Table 5].
|Table 5: Multivariate logistic regression analysis to assess the risk factors association with child overweight|
Click here to view
| Discussion|| |
Many investigators have previously suggested an intricate picture in which many factors may simultaneously influence the relation of caries and obesity. Such plausible factors are caries risk, physical activity, TV watching, and parental obesity. For this reason the present study has attempted to analyze this ambiguous relation.
Neither "Obesity increases risk of caries" nor "caries increases risk of obesity," but rather a common risk factor increased the likelihood of both diseases. Dietary factors and SES were hypothesized to be common risk factors that potentially link obesity and dental caries. In our study there was high statistical significance observed between overweight and SES which correlates with the study done by Wang Y et al. The percentile distribution of BMI shows 20% of school children were at 'Risk for overweight' and 40% are 'overweight' these results equivocate with the study done Khadilkar et al.,  and higher incidence of overweight was observed among boys (40.3%) than in girls (35.6%).
Also, more percent of overweight was observed among private school children than government school children, is similar with the findings of study done by Gupta DK et.al.  The possible reason could be comparatively high family income that have led to easy access to high caloric food (fast foods, junk foods) and availability of less physically active recreation environment to these children.
The dietary habits of children that contribute to obesity could also increase caries risk. Our study did not show relationship between caries risk and caries experience which does not correlates with the findings of study done by Sudha P.  The possible reason could be that, assessment of caries risk was performed through a 24-hour recall diet interview which might have not given the complete diet history to prove this association.
The true etiology of both obesity and dental caries is complex and multifactorial. Many of the contributing factors are rooted in evolving changes in lifestyle and the internal body as well as external environment. The present study showed no relation between overweight and dental caries and is in accordance with the studies conducted by Macek,  Hong,  Jamelli,  Gokhale,  and Sudhakar. 
In addition to this, lack of physical activity and TV watching for long duration might also contribute to this relation. A statistical significant relation) was observed between BMI and TV watching among study subjects this simulates with Hancox.  Also BMI percentiles and physical activity of children showed a statistical significance) which equivocates with the longitudinal study done by Maffeis. 
Hence, the importance of physical activity in the prevalence of overweight was evident from our study. Lack of sports activity, more time spent on TV/computer, and inadequate aerobic exercise showed significant association with overweight/obesity.
Another important finding of our study is that, there was a positive correlation observed between child and parental BMI values. The observed odds ratio shows that parental overweight and obesity are considerable risk factors for childhood overweight and obesity this observation is consistent with the study done by Ramesh K  and Richard S. 
When multivariate logistic regression analysis was applied among observed risk factors in our study, parental overweight, SES and TV watching more than 6 hours/day were found to be positively related with childhood overweight.
It is important to consider the limitations of the study. First one being the data collected was cross-sectional and the study was performed on a small geographic location.
| Conclusions|| |
In conclusion, overweight and dental caries were not significantly related but parental overweight, SES and TV watching were found to be positively related with childhood overweight. Furthermore, there is a warranted need for the initiation of longitudinal studies to analyze it on a broader representative population.
| References|| |
|1.||Thakur JS. Emerging epidemic of non communicable diseases-an urgent need for control initiative. Indian J Community Med 2005;30:4. |
|2.||Gupta DK, Shah P, Misra A, Bharadwaj S, Gulati S, Gupta N, et al. Secular trends in prevalence of overweight and obesity from 2006 to 2009 in urban Asian Indian adolescents aged 14-17 years. PLoS One 2011;6:e17221. |
|3.||Kaur S, Sachdev HP, Dwivedi SN, Lakshmy R, Kapil U. Prevalence of overweight and obesity amongst school children in Delhi, India. Asia Pac J Clin Nutr 2008;17:592-6. |
|4.||Kotian MS, S GK, Kotian SS. Prevalence and determinants of overweight and obesity among adolescent school children of South Karnataka, India. Indian J Community Med 2010;35:176-8. |
|5.||Badawi NE, Barakat AA, El-Sherbini SA, Fawzy HM. Prevalence of overweight and obesity in primary school children in Port Said city. Egypt Pediatr Assoc Gaz 2013;61:31-6. |
|6.||Aounallah-Skhiri H, Traissac P, El Ati J, Eymard-Duvernay S, Landais E, Achour N, et al. Nutrition transition among adolescents of a south-Mediterranean country: Dietary patterns, association with socio-economic factors, overweight and blood pressure. A cross-sectional study in Tunisia. Nutr J 2011;10:38. |
|7.||Sidhu S, Kumari K. Incidence of overweight and obesity among urban and rural males of Amritsar. J Exerc Sci Physiother 2006;2:79-83. |
|8.||Tripathi S, Kiran K, Kamala BK. Relationship between obesity and dental caries in children - A preliminary study. J Int Oral Health 2010;2:65-72. |
|9.||Thippeswamy HM, Kumar N, Acharya S, Pentapati KC. Relationship between body mass index and dental caries among adolescent children in South India. West Indian Med J 2011;60:581-6. |
|10.||Ramesh K. The prevalence of overweight and obesity and the factors associated with it among high school students in Thiruvanthapurum City Corporation, Kerala, India. Australas Med J 2010;3:650-6. |
|11.||Gokhale N, Sivakumar N, Nirmala SVSG, Abinash M. Dental caries and body mass index in children of Nellore. J Orofac Sci 2010;2:4-6. |
|12.||Khadilkar VV, Khadilkar AV, Choudhury P, Agarwal KN, Ugra D, Shah NK. IAP growth monitoring guidelines for children from birth to 18 years. Indian Pediatr 2007;44:187-97. |
|13.||Naidu AN, Rao NP. Body mass index: A measure of the nutritional status in Indian population. Eur J Clin Nutr 1994;48 Suppl 3:S131-40. |
|14.||Kumar N, Shekhar C, Kumar P, Kundu AS. Kuppuswamy's socioeconomic status scale-updating for 2007. Indian J Pediatr 2007;74:1131-2. |
|15.||Marshall TA. Chairside diet assessment of caries risk. J Am Dent Assoc 2009;140:670-4. |
|16.||World health organization. Global recommendations on physical activity for health; 2010. |
|17.||Wang Y. Cross-national comparison of childhood obesity: The epidemic and the relationship between obesity and socioeconomic status. Int J Epidemiol 2001;30:1129-36. |
|18.||Khadilkar VV, Khadilkar AV, Borade AB, Chiplonkar SA. Body mass index cut-offs for screening for childhood overweight and obesity in Indian children. Indian Pediatr 2012;49:29-34. |
|19.||Sudha P, Bhasin S, Anegundi RT. Prevalence of dental caries among 5-13-year-old children of Mangalore city. J Indian Soc Pedod Prev Dent 2005;23:74-9. |
|20.||Macek MD, Mitola DJ. Exploring the association between overweight and dental caries among US children. Pediatr Dent 2006;28:375-80. |
|21.||Hong L, Ahmed A, McCunniff M, Overman P, Mathew M. Obesity and dental caries in children aged 2-6years in the United States: National Health and Nutrition Examination Survey 1999-2002. J Public Health Dent 2008;68:227-33. |
|22.||Jamelli SR, Rodrigues CS, de Lira PI. Nutritional status and prevalence of dental caries among 12-year-old children at public schools: A case-control study. Oral Health Prev Dent 2010;8:77-84. |
|23.||Sudhakar K, Sharath PR, Shanti M, Fareed N, Sudhir KM. Relationship between dentition status and body mass index among 5-15 years old age group children of an orphanage in Nellore city.Journal of Indian Association of Public Health Dentistry JIAPHD 2010;15:45-8. |
|24.||Hancox RJ, Poulton R. Watching television is associated with childhood obesity: But is it clinically important? Int J Obes (Lond) 2006;30:171-5. |
|25.||Maffeis C, Talamini G, Tatò L. Influence of diet, physical activity and parents' obesity on children's adiposity: A four-year longitudinal study. Int J Obes Relat Metab Disord 1998;22:758-64. |
|26.||Strauss RS, Knight J. Influence of the home environment on the development of obesity in children. Pediatrics 1999;103:e85. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]