Feeding practices in infancy associated with caries incidence in early childhood

BACKGROUND: Early-life feeding behaviors foretell later dietary habits and health outcomes. Few studies have examined infant dietary patterns and caries occurrence prospectively. OBJECTIVE: Assess whether patterns in food and drink consumption before age 12 months are associated with caries incidence by preschool age. METHODS: We collected early-life feeding data within a birth cohort from low-income families in Porto Alegre, Brazil. Three dietary indexes were defined, based on refined sugar content and/or previously reported caries associations: a count of sweet foods or drinks introduced <6-months (e.g., candy, cookies, soft drinks), a count of other, nonsweet items introduced <6-months (e.g., beans, meat), and a count of sweet items consumed at 12 months. Incidence of severe early childhood caries (S-ECC) at age 38 months (N = 458) was compared by score tertile on each index, adjusted for family, maternal, and child characteristics using regression modeling. RESULTS: Introduction to a greater number of presumably cariogenic items in infancy was positively associated with future caries. S-ECC incidence was highest in the uppermost tertile of the '6-month sweet index' (adjusted cumulative incidence ratio, RR, versus lowest tertile: 1.46; 95% CI: 0.97, 2.04) and the uppermost tertile of the '12-month sweet index' (RR: 1.55; 95% CI: 1.17, 2.23). The association was specific for sweet items: caries incidence did not differ by tertile of the '6-month nonsweet index' (RR: 1.00; 95% CI: 0.70, 1.40). Additionally, each one-unit increase on the 6-month and the 12-month sweet indexes, but not the 6-month nonsweet index, was statistically significantly associated with greater S-ECC incidence and associated with more decayed, missing, or restored teeth. Results were robust to minor changes in the items constituting each index and persisted if liquid items were excluded. CONCLUSIONS: Dietary factors observed before age 12-months were associated with S-ECC at preschool age, highlighting a need for timely, multilevel intervention.