Sugary Liquids in the Baby Bottle: Risk for Child Undernutrition and Severe Tooth Decay in Rural El Salvador
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Data Collection
2.3. Statistical Analysis
3. Results
3.1. Demographic Characteristics
3.2. Child Dietary Habits and Maternal Health Knowledge
3.3. Child Oral Health and Nutritional Status
3.4. Risk Factors for Child Underweight
3.5. Risk Factors for Child Severe Caries Outcomes
4. Discussion
4.1. Sugar-Sweetened Beverages (SSBs), Bottle Feeding, and Adverse Health Outcomes
4.2. Association between Early Childhood Caries (ECC) and Undernutrition
4.3. Demographics and Socioeconomic Determinants
4.4. Recommendations
4.5. Study Limitations and Strengths
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A. Case Study—Bottle-Feeding with Sugary Drinks, Severe Early Childhood Caries, and Malnutrition
References
- Popkin, B.M.; Adair, L.S.; Ng, S.W. Global Nutrition Transition and the Pandemic of Obesity in Developing Countries. Nutr. Rev. 2012, 70, 3–21. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Gómez, G.; Fisberg, R.M.; Nogueira Previdelli, Á.; Hermes Sales, C.; Kovalskys, I.; Fisberg, M.; Herrera-Cuenca, M.; Cortés Sanabria, L.Y.; García, M.C.Y.; Pareja Torres, R.G.; et al. Diet Quality and Diet Diversity in Eight Latin American Countries: Results from the Latin American Study of Nutrition and Health (ELANS). Nutrients 2019, 11, 1605. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Fact Sheets—Malnutrition. Available online: https://www.who.int/news-room/fact-sheets/detail/malnutrition (accessed on 15 December 2020).
- World Health Organization. UNICEF-WHO-The World Bank: Joint Child Malnutrition Estimates—Levels and Trends. 2020. Available online: https://www.who.int/nutgrowthdb/estimates/en/ (accessed on 14 April 2020).
- Vieira, K.A.; Rosa-Júnior, L.S.; Souza, M.A.V.; Santos, N.B.; Florêncio, T.M.M.T.; Bussadori, S.K. Chronic Malnutrition and Oral Health Status in Children Aged 1 to 5 Years: An Observational Study. Medicine 2020, 99, e19595. [Google Scholar] [CrossRef]
- Kassebaum, N.J.; Smith, A.G.C.; Bernabé, E.; Fleming, T.D.; Reynolds, A.E.; Vos, T.; Murray, C.J.L.; Marcenes, W.; GBD 2015 Oral Health Collaborators; Abyu, G.Y.; et al. Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990–2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors. J. Dent. Res. 2017, 96, 380–387. [Google Scholar] [CrossRef]
- Tsang, C.; Sokal-Gutierrez, K.; Patel, P.; Lewis, B.; Huang, D.; Ronsin, K.; Baral, A.; Bhatta, A.; Khadka, N.; Barkan, H.; et al. Early Childhood Oral Health and Nutrition in Urban and Rural Nepal. Int. J. Environ. Res. Public Health 2019, 16, 2456. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tinanoff, N.; Baez, R.J.; Diaz Guillory, C.; Donly, K.J.; Feldens, C.A.; McGrath, C.; Phantumvanit, P.; Pitts, N.B.; Seow, W.K.; Sharkov, N.; et al. Early Childhood Caries Epidemiology, Aetiology, Risk Assessment, Societal Burden, Management, Education, and Policy: Global Perspective. Int. J. Paediatr. Dent. 2019, 29, 238–248. [Google Scholar] [CrossRef] [PubMed]
- Dülgergil, Ç.; Dalli, M.; Hamidi, M.; Çolak, H. Early Childhood Caries Update: A Review of Causes, Diagnoses, and Treatments. J. Nat. Sci. Biol. Med. 2013, 4, 29. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- World Health Organization. Ending Childhood Dental Caries: WHO Implementation Manual. 2020. Available online: https://www.who.int/publications/i/item/ending-childhood-dental-caries-who-implementation-manual (accessed on 1 February 2020).
- American Association of Pediatric Dentists. Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. 2016. Available online: https://www.aapd.org/research/oral-health-policies--recommendations/early-childhood-caries-classifications-consequences-and-preventive-strategies/ (accessed on 29 August 2020).
- Sheiham, A.; James, W. Diet and Dental Caries: The Pivotal Role of Free Sugars Reemphasized. J. Dent. Res. 2015, 94, 1341–1347. [Google Scholar] [CrossRef] [PubMed]
- Dimaisip-Nabuab, J.; Duijster, D.; Benzian, H.; Heinrich-Weltzien, R.; Homsavath, A.; Monse, B.; Sithan, H.; Stauf, N.; Susilawati, S.; Kromeyer-Hauschild, K. Nutritional Status, Dental Caries and Tooth Eruption in Children: A Longitudinal Study in Cambodia, Indonesia and Lao PDR. BMC Pediatr. 2018, 18, 300. [Google Scholar] [CrossRef] [Green Version]
- World Food Programme. El Costo de la Doble Carga de la Malnutrición. Impacto Social y Económico en El Salvador. 2019. Available online: https://es.wfp.org/publicaciones/el-costo-de-la-doble-carga-de-la-malnutricion-el-salvador (accessed on 12 March 2020).
- World Bank; Shrimpton, R.; Rokx, C. The Double Burden of Malnutrition: A Review of Global Evidence. 2012. Available online: https://openknowledge.worldbank.org/handle/10986/27417 (accessed on 12 June 2020).
- World Food Programme. El Salvador. Available online: https://www.wfp.org/countries/el-salvador (accessed on 12 March 2020).
- Dabiri, D.; Fontana, M.; Kapila, Y.; Eckert, G.; Sokal-Gutierrez, K. Community-Based Assessment and Intervention for Early Childhood Caries in Rural El Salvador. Int. Dent. J. 2016, 66, 221–228. [Google Scholar] [CrossRef]
- Achalu, P.; Zahid, N.; Sherry, D.N.; Chang, A.; Sokal-Gutierrez, K. A Qualitative Study of Child Nutrition and Oral Health in El Salvador. Int. J. Environ. Res. Public Health 2019, 16, 2508. [Google Scholar] [CrossRef] [Green Version]
- Conde, W.L.; Monteiro, C.A. Nutrition Transition and Double Burden of Undernutrition and Excess of Weight in Brazil. Am. J. Clin. Nutr. 2014, 100, 1617S–1622S. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Oral Health Surveys: Basic Methods, 5th ed.; School of Dentistry, University of Sao Paolo: Sao Paolo, Brazil, 2013; Available online: https://www.who.int/oral_health/publications/9789241548649/en/ (accessed on 3 February 2019).
- World Health Organization. WHO Child Growth Standards: Length/Height-For-Age, Weight-For-Age, Weight-For-Length, Weight-For-Height and Body Mass Index-For-Age; Methods and Development; World Health Organization: Geneva, Switzerland, 2006; ISBN 978-92-4-154693-5. [Google Scholar]
- WHO. AnthroPlus for Personal Computers Manual: Software for Assessing Growth of the World’s Children and Adolescents; WHO: Geneva, Switzerland, 2009; Available online: http://www.who.int/growthref/tools/en/ (accessed on 20 August 2018).
- Yu, R.; Wang, Y.; Xiao, Y.; Mo, L.; Liu, A.; Li, D.; Ge, T.; Yu, G.; Zhang, T. Prevalence of Malnutrition and Risk of Undernutrition in Hospitalised Children with Liver Disease. J. Nutr. Sci. 2017, 6, e55. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Das, S.; Rahman, R.M. Application of Ordinal Logistic Regression Analysis in Determining Risk Factors of Child Malnutrition in Bangladesh. Nutr. J. 2011, 10, 124. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Fagerland, M.W.; Hosmer, D.W. Tests for Goodness of Fit in Ordinal Logistic Regression Models. J. Stat. Comput. 2016, 86, 3398–3418. [Google Scholar] [CrossRef]
- Williams, R. Understanding and Interpreting Generalized Ordered Logit Models. J. Math. Sociol. 2016, 40, 7–20. [Google Scholar] [CrossRef]
- Branger, B.; Camelot, F.; Droz, D.; Houbiers, B.; Marchalot, A.; Bruel, H.; Laczny, E.; Clement, C. Breastfeeding and Early Childhood Caries. Review of the Literature, Recommendations, and Prevention. Archives de Pédiatrie 2019, 26, 497–503. [Google Scholar] [CrossRef]
- Black, R.E.; Victora, C.G.; Walker, S.P.; Bhutta, Z.A.; Christian, P.; de Onis, M.; Ezzati, M.; Grantham-McGregor, S.; Katz, J.; Martorell, R.; et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013, 382, 427–451. [Google Scholar] [CrossRef]
- Moodie, R.; Stuckler, D.; Monteiro, C.; Sheron, N.; Neal, B.; Thamarangsi, T.; Lincoln, P.; Casswell, S.; The Lancet NCD Action Group. Profits and pandemics: Prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet 2013, 381, 670–679. [Google Scholar] [CrossRef]
- Andrei, K.; Dona, I.D.A.; Cristina, B.; Doriana, A.-F. A Study Concerning Tooth Decay Incidence in Children with Ages Between 3 and 6 Years. ARS Medica Tomitana 2018, 24, 174–178. [Google Scholar] [CrossRef] [Green Version]
- Park, S.; Lin, M.; Onufrak, S.; Li, R. Association of Sugar-Sweetened Beverage Intake during Infancy with Dental Caries in 6-Year-Olds. Clin. Nutr. Res. 2015, 4, 9. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Rusali, R.; Najwa Hamali, N.; Muhammad Razi, F.; Mustafa, N.; Asilah Harun, N.; Azwani Mohd Shukri, N. Early Childhood Feeding Practices and Its Association with Early Childhood Caries. J. Food Nutr. Res. 2019, 7, 801–804. [Google Scholar] [CrossRef] [Green Version]
- Chen, D.; Zhi, Q.; Zhou, Y.; Tao, Y.; Wu, L.; Lin, H. Association between Dental Caries and BMI in 367 Children: A Systematic Review and Meta-Analysis. Caries Res. 2018, 52, 230–245. [Google Scholar] [CrossRef] [PubMed]
- Davis, J.N.; Koleilat, M.; Shearrer, G.E.; Whaley, S.E. Association of Infant Feeding and Dietary Intake on Obesity Prevalence in Low-Income Toddlers: Infant Feeding and Obesity in Hispanics. Obesity 2014, 22, 1103–1111. [Google Scholar] [CrossRef] [PubMed]
- Bai, Y.; Wunderlich, S.M. Lactation accommodation in the workplace and duration of exclusive breastfeeding. J. Midwifery Womens Health 2013, 58, 690–696. [Google Scholar] [CrossRef]
- Poirier, K.; Totosy de Zepetnek, J.; Bennett, L.; Brett, N.; Boateng, T.; Schwartz, A.; Luhovyy, B.; Bellissimo, N. Effect of Commercially Available Sugar-Sweetened Beverages on Subjective Appetite and Short-Term Food Intake in Boys. Nutrients 2019, 11, 270. [Google Scholar] [CrossRef] [Green Version]
- Bonjour, S.; Adair-Rohani, H.; Wolf, J.; Bruce, N.G.; Mehta, S.; Prüss-Ustün, A.; Lahiff, M.; Rehfuess, E.A.; Mishra, V.; Smith, K.R. Solid Fuel Use for Household Cooking: Country and Regional Estimates for 1980–2010. Environ. Health Perspect. 2013, 121, 784–790. [Google Scholar] [CrossRef] [Green Version]
- Kayamba, V.; Heimburger, D.C.; Morgan, D.R.; Atadzhanov, M.; Kelly, P. Exposure to Biomass Smoke as a Risk Factor for Oesophageal and Gastric Cancer in Low-Income Populations: A Systematic Review. Mal. Med. J. 2017, 29, 212. [Google Scholar] [CrossRef] [Green Version]
- Thornton, R.L.J.; Glover, C.M.; Cené, C.W.; Glik, D.C.; Henderson, J.A.; Williams, D.R. Evaluating Strategies for Reducing Health Disparities by Addressing the Social Determinants of Health. Health Aff. 2016, 35, 1416–1423. [Google Scholar] [CrossRef] [Green Version]
- Pan American Health Organization. Plan of Action for the Prevention of Obesity in Children and Adolescents. 2015. Available online: https://www.paho.org/hq/dmdocuments/2015/Obesity-Plan-Of-Action-Child-Eng-2015.pdf?ua=1&ua=1 (accessed on 13 December 2018).
- Section on Oral Health. Maintaining and Improving the Oral Health of Young Children. Pediatrics 2014, 134, 1224–1229. [Google Scholar] [CrossRef] [Green Version]
- Salud Oral Factores de Riesgo (SOFAR). Available online: https://www.paho.org/sofar/actividades.html (accessed on 2 October 2020).
- Villena, R.S.; Pesaressi, E.; Frencken, J.E. Reducing Carious Lesions during the First 4 Years of Life: An Interprofessional Approach. J. Am. Dent. Assoc. 2019, 150, 1004–1014. [Google Scholar] [CrossRef] [PubMed]
- Fiese, B.H.; Jones, B.L. Food and Family: A Socio-Ecological Perspective for Child Development. Adv. Child Dev. Behav. 2012, 42, 307–337. [Google Scholar] [PubMed]
- Corvalán, C.; Garmendia, M.L.; Jones-Smith, J.; Lutter, C.K.; Miranda, J.J.; Pedraza, L.S.; Popkin, B.M.; Ramirez-Zea, M.; Salvo, D.; Stein, A.D. Nutrition Status of Children in Latin America: Nutrition Status of the Latin American Region. Obes. Rev. 2017, 18, 7–18. [Google Scholar] [CrossRef] [PubMed]
- ReliefWeb. Presidente Sanchez Ceren lanza Politica Nacional de Seguridad Alimentaria y Nutricional 2018–2028—El Salvador. Available online: https://reliefweb.int/report/el-salvador/presidente-s-nchez-cer-n-lanza-pol-tica-nacional-de-seguridad-alimentaria-y (accessed on 12 March 2020).
- Théodore, F.L.; Moreno-Saracho, J.E.; Bonvecchio, A.; Morales-Ruán, M.d.C.; Tolentino-Mayo, L.; López-Olmedo, N.; Shamah-Levy, T.; Rivera, J.A. Lessons Learned and Insights from the Implementation of a Food and Physical Activity Policy to Prevent Obesity in Mexican Schools: An Analysis of Nationally Representative Survey Results. PLoS ONE 2018, 13, e0198585. [Google Scholar] [CrossRef] [PubMed]
- Hilari, C.; Franco, M. What Is Needed to Improve Food Sales in Schools? Food Vendors’ Opinion from El Salvador. Front. Public Health 2015, 3, 168. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Amanzadeh, B.; Sokal-Gutierrez, K.; Barker, J.C. An Interpretive Study of Food, Snack and Beverage Advertisements in Rural and Urban El Salvador. BMC Public Health 2015, 15, 521. [Google Scholar] [CrossRef] [Green Version]
- Country Report: El Salvador. Available online: https://www.paho.org/salud-en-las-americas-2017/?page_id=119 (accessed on 16 December 2020).
- Wallerstein, N.; Duran, B. Community-Based Participatory Research Contributions to Intervention Research: The Intersection of Science and Practice to Improve Health Equity. Am. J. Public Health 2010, 100, S40–S46. [Google Scholar] [CrossRef]
- Weisstaub, G.; Aguilar, A.M.; Uauy, R. Treatment and Prevention of Malnutrition in Latin America: Focus on Chile and Bolivia. Food Nutr. Bull. 2014, 35, S39–S46. [Google Scholar] [CrossRef] [Green Version]
Participant Demographics (n Total Respondents) | n (%) or Mean ± s.d. |
---|---|
Mother and Family Characteristics | |
Mother’s Age (years) (n = 591) | 29.0 ± 8.9 |
Formal Education (mean) (n = 574) | 5.6 ± 3.8 |
Formal Education (years) (n = 574) | |
0 | 12.0% |
1–3 | 19.3% |
4–7 | 38.9% |
8+ | 29.8% |
Family Size (mean) (n = 582) | 5.5 ± 2.4 |
Family Size (n) (n = 582) | |
2–4 | 18.2% |
5–7 | 64.4% |
8+ | 17.4% |
Potable Water at Home (n = 589) | 56.2% |
Electric Lighting at Home (n = 590) | 84.4% |
Cooking Fuel Source (n = 590) | |
Wood Only | 27.9% |
Gas Only | 13.2% |
Both Wood and Gas | 58.9% |
Caregivers Receiving Prenatal Care (n = 797) | 91.7% |
Children with Completed Vaccinations (n = 797) | 94.8% |
Children who Visited Dentist At least Once (n = 796) | 16.6% |
Child Characteristics (n = 797) | |
Age (mean) | 2.9 ± 1.6 |
Age (years) | |
(0.5–1] | 12.3% |
(1–2] | 22.5% |
(2–3] | 20.1% |
(3–4] | 13.0% |
(4–5] | 14.9% |
(5–6] | 17.1% |
Sex | |
Male | 51.1% |
Female | 48.9% |
Nutrition/Oral Health Metric (n Total Respondents) | n (%) or Mean ± s.d. |
---|---|
Child Nutrition Practices (n = 793) | |
Ever breastfed | 94.3% |
Mean breastfeeding duration (months) | 17.2 ± 8.6 |
Range breastfeeding duration (months) | 1–52 |
Ever bottle-fed | 45.8% |
Mixed bottle-fed and breastfed | 42.6% |
Mean bottle-feeding duration (months) | 24.7 ± 12.7 |
Range bottle-feeding duration (months) | 1–54 |
Bottle for sleeping 1 | 33.3% |
Baby bottle contents 1,2 | |
SSBs 3 in the bottle | 73.0% |
Milk | 80.2% |
Incaparina 4 | 33.6% |
Juice with sugar | 28.9% |
Lemonade | 28.4% |
Sugar water | 17.1% |
Soda | 12.9% |
Baby milk formula | 9.9% |
Coffee with sugar | 9.9% |
Children’s Frequency of Consumption1 | |
Milk (n = 777) | |
Infrequently (never or rarely) | 30.4% |
Weekly | 15.1% |
Daily | 54.4% |
Soda/juice (n = 799) | |
Infrequently (never or rarely) | 58.4% |
Weekly | 35.4% |
Daily | 6.2% |
Candy/sweets (n = 784) | |
Infrequently (never or rarely) | 44.4% |
Weekly | 33.4% |
Daily | 22.2% |
Maternal Oral Health Knowledge1 | |
Causes of caries (n = 591) | |
Not brushing frequently | 63.2% |
Candy/sweets | 29.6% |
Soda/juice | 15.1% |
Baby bottle | 12.9% |
Consequences of caries (n = 590) | |
Trouble eating | 88.5% |
Mouth pain | 53.2% |
Rotting teeth | 39.8% |
Problems sleeping | 10.8% |
Poor overall health | 5.3% |
Maternal Perception of Children’s Health | |
Mother’s opinion of their child’s teeth (n = 771) | |
Excellent | 38.9% |
Okay | 35.3% |
Bad | 25.8% |
Mother’s opinion of their child’s overall health (n = 784) | |
Excellent | 36.8% |
Okay | 36.9% |
Bad | 26.2% |
Descriptive Variable | n (%) or Mean ± s.d. |
---|---|
Nutritional Status | |
Moderate or severe undernutrition (WAZ ≤ −2.0) 1 | 10.4% |
At risk for developing undernutrition (WAZ ≤ −1.0) 1 | 24.1% |
Did not develop undernutrition (WAZ > −1.0) 1 | 65.4% |
Overweight or obese (WAZ > 2.0) 1 | 5.2% |
Mean WAZ score 1 | −0.6 ± 1.2 |
Mean HAZ score 2 | −1.3 ± 1.2 |
Mean WHZ score 3 | −0.1 ± 1.3 |
Oral Health Status | |
Early childhood caries (ECC) | 47.4% |
Severe early childhood caries (sECC) | 31.0% |
Mean number of decayed teeth (dmft) 4 | 2.8 ± 3.9 |
Range number of decayed teeth | 16 |
dmft 1–3 | 16.1% |
dmft 4–6 | 13.9% |
dmft 7–9 | 8.4% |
dmft 10+ | 9.0% |
Untreated tooth decay | 97.3% |
Reported mouth pain | 19.3% |
Co-Variates | Β 2 | SE 3 | OR 4 | 95% CI 5 | p-Value |
---|---|---|---|---|---|
Intercept a: Did not develop undernutrition | At risk for undernutrition | 0.87 | 0.30 | - | - | 0.003 |
Intercept b: At risk for undernutrition | Developed undernutrition | 2.41 | 0.32 | - | - | 0.000 |
SSB 6 in baby bottle Reference: No SSB used SSB Used | 0.81 | 0.32 | 2.26 | 1.32–3.82 | 0.011 |
Number of dmft 7 | 0.05 | 0.02 | 1.05 | 1.01–1.09 | 0.023 |
Cooking fuel source Reference: Both gas and wood Gas only Wood only | 0.25 0.46 | 0.26 0.20 | 1.28 1.60 | 0.82–1.97 1.14–2.23 | 0.349 0.022 |
Child sex Reference: Female Male | 0.13 | 0.18 | 1.13 | 0.85–1.52 | 0.479 |
Maternal education level Reference: No formal education 1–7 years 8+ years | −0.22 −0.13 | 0.28 0.33 | 0.81 0.88 | 0.52–1.28 0.51–1.52 | 0.442 0.700 |
Co-Variates | Β 1 | SE 2 | OR 3 | 95% CI 4 | p-Value |
---|---|---|---|---|---|
Intercept: No sECC | sECC | −3.09 | 0.52 | - | - | 0.000 |
SSB 5 in baby bottle Reference: No SSB used SSB Used | 0.43 | 0.21 | 1.53 | 1.07–2.18 | 0.047 |
Child age (continuous) | 0.45 | 0.06 | 1.57 | 1.42–1.74 | 0.000 |
Maternal education level Reference: No formal education 1–7 years 8+ years | 0.34 0.11 | 0.34 0.40 | 1.41 1.11 | 0.81–2.51 0.58–2.18 | 0.312 0.783 |
Cooking fuel source Reference: Both gas and wood Gas only Wood only | −0.34 0.02 | 0.31 0.26 | 0.71 1.02 | 0.42–1.16 0.67–1.56 | 0.262 0.933 |
Child sex Reference: Female Male | −0.34 | 0.20 | 0.71 | 0.51–0.99 | 0.091 |
In-home electric lighting Reference: Not available Available | 0.52 | 0.33 | 1.68 | 0.99–2.91 | 0.114 |
Running potable water Reference: Not available Available | 0.26 | 0.22 | 1.30 | 0.92–1.86 | 0.219 |
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Achalu, P.; Bhatia, A.; Turton, B.; Luna, L.; Sokal-Gutierrez, K. Sugary Liquids in the Baby Bottle: Risk for Child Undernutrition and Severe Tooth Decay in Rural El Salvador. Int. J. Environ. Res. Public Health 2021, 18, 260. https://doi.org/10.3390/ijerph18010260
Achalu P, Bhatia A, Turton B, Luna L, Sokal-Gutierrez K. Sugary Liquids in the Baby Bottle: Risk for Child Undernutrition and Severe Tooth Decay in Rural El Salvador. International Journal of Environmental Research and Public Health. 2021; 18(1):260. https://doi.org/10.3390/ijerph18010260
Chicago/Turabian StyleAchalu, Priyanka, Abhishek Bhatia, Bathsheba Turton, Lucy Luna, and Karen Sokal-Gutierrez. 2021. "Sugary Liquids in the Baby Bottle: Risk for Child Undernutrition and Severe Tooth Decay in Rural El Salvador" International Journal of Environmental Research and Public Health 18, no. 1: 260. https://doi.org/10.3390/ijerph18010260
APA StyleAchalu, P., Bhatia, A., Turton, B., Luna, L., & Sokal-Gutierrez, K. (2021). Sugary Liquids in the Baby Bottle: Risk for Child Undernutrition and Severe Tooth Decay in Rural El Salvador. International Journal of Environmental Research and Public Health, 18(1), 260. https://doi.org/10.3390/ijerph18010260