Common Determinants of Dental Caries and Obesity in Children: A Multi-Ethnic Nested Birth Cohort Study in the United Kingdom
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources
2.1.1. The Born in Bradford Cohort Study
2.1.2. Dental Data
2.2. Outcome Measures
2.2.1. Nutritional Status
2.2.2. Dental Caries
2.2.3. Family-Level and Child-Level Determinants
2.3. Data Analysis
2.3.1. Descriptive Analysis
2.3.2. Missing Data and Multiple Imputation
2.3.3. Structural Equation Modelling
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
Appendix A
Variable Description | Missing Data Value | Percentage of Missing Data |
---|---|---|
Weight status of the child | 0/171 | 0% |
Deprivation status | 0/171 | 0% |
Dental caries of the child | 0/171 | 0% |
Ethnicity | 0/171 | 0% |
Sex of the child | 0/171 | 0% |
Mother’s age at birth | 0/171 | 0% |
Breastfed child | 30/171 | 18% |
Caregivers feeding style | 30/171 | 18% |
Hours of sleep per day child (excluded in parsimonious model) | 31/171 | 18% |
Physical activity of the child | 30/171 | 18% |
Daily TV hours during weekday of the child | 32/171 | 19% |
Parental psychological wellbeing | 35/171 | 20% |
Emotional and behavioural wellbeing child | 35/171 | 20% |
Frequency drinking sugar-sweetened beverages child | 38/171 | 22% |
Maternal alcohol consumption | 61/171 | 36% |
Appendix B
Appendix B.1. Multiple Imputation, Structural Equation Modelling and Fit Indexes
- 1.
- mvdecode (varlist), mv (99), or mvdecode (varlist), mv (999)
- 2.
- mi set mlong
- 3.
- mi register imputed (varlist)
- 4.
- mi impute mvn missing = nonmissing, add (40)
- 5.
- sem, standardized
- 6.
- estat gov, stats (all)
- 7.
- mi estimate, cmdok: sem
Appendix B.2. Parsimonious Framework
Appendix C
Variable | Categories | Number of Participants | Percentage |
---|---|---|---|
Deprivation status | Least deprived and most educated | 23 | 13.5 |
Employed and not materially deprived | 23 | 13.5 | |
Employed, no access to money | 27 | 15.8 | |
Benefits but coping | 62 | 36.2 | |
Most deprived | 36 | 21.0 | |
Alcohol consumption mother | Yes | 30 | 27.3 |
No | 80 | 72.7 | |
Mother’s age at birth | Under 25 years of age | 62 | 36.2 |
Between 25–30 years of age | 60 | 35.1 | |
Older than 30 | 49 | 28.7 | |
Breastfed child | Yes | 92 | 65.2 |
No | 49 | 34.8 | |
Parental psychological wellbeing | normal health (threshold 23) | 120 | 88.2 |
worse condition/distress | 16 | 11.8 | |
Caregivers feeding style | Authoritarian | 2 | 1.4 |
Authoritative | 69 | 48.9 | |
Indulgent | 49 | 34.8 | |
Uninvolved | 21 | 14.9 | |
Ethnicity | White British | 54 | 31.6 |
Pakistani | 100 | 60.2 | |
Other | 14 | 8.2 | |
Physical activity | Never active | 16 | 11.3 |
Once a month to once a week | 61 | 43.3 | |
Twice a week to 7 times a week | 64 | 45.4 | |
Sex | Male | 79 | 46.2 |
Female | 92 | 53.8 | |
Daily TV hours during weekday of the child | None | 17 | 12.3 |
Up to one hour | 52 | 37.2 | |
1–2 h | 31 | 22.3 | |
2–3 h | 26 | 18.7 | |
More than 3 h | 13 | 9.5 | |
Frequency drinking sugar-sweetened beverages child | Very low consumption | 86 | 64.7 |
Medium to very high | 47 | 35.3 | |
Emotional and behavioural wellbeing child | Close to average | 66 | 48.5 |
Slightly decreased | 29 | 21.3 | |
Low | 15 | 11.0 | |
Very low | 26 | 19.2 | |
Hours of sleep per day | Less than 10 h | 10 | 7.1 |
Between 10–12 h | 60 | 42.9 | |
12.5–14 h | 60 | 42.9 | |
More than 14 h | 10 | 7.1 |
Appendix D
Variable | BMI Category | Dental Caries | ||
categorical score
| continuous score (dmft) from 0–20 indicating teeth affected by dental caries | |||
ß | 95% CI | ß | 95% CI | |
Alcohol consumption mother after giving birth
| 0.1 | 0.0, 0.1 | 0.1 | 0.0, 0.1 |
Frequency drinking sugar-sweetened beverages of the child
| 0.1 | 0.1, 0.1 | 0.1 | 0.0, 0.1 |
Emotional and behavioural wellbeing of the child Sequential, higher score = less normal situation | 0.2 | 0.2, 0.3 | 0.2 | 0.2, 0.2 |
Caregivers feeding style score
| 0.3 | 0.3, 0.3 | −0.1 | −0.1, −0.0 |
Child’s sex
| −0.1 | −0.1, −0.1 | −0.1 | −0.1, −0.1 |
Deprivation status
| −0.1 | −0.1, −0.0 | 0.24 | 0.21, 0.26 |
Mother’s age at birth Sequential, higher score = older age | −0.1 | −0.1, −0.0 | ||
Breastfed
| −0.2 | −0.3, −0.2 | ||
Parental psychological wellbeing Sequential, higher score = psychological distress | 0.2 | 0.2, 0.2 | ||
Ethnicity
| 0.5 | 0.2, 0.1 | ||
Physical activity of the child
| 0.1 | 0.0, 0.1 |
Appendix E
Indirect Effects of Family-Level and Child-Level Determinants with Child’s Dental Caries and Child’s BMI
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Variable Name | Source | Description of Variable | Categories |
---|---|---|---|
Family-Level Determinants | |||
Deprivation status | Various BiB sources | The variable describes the SES of the family the child grows up in. The variable derives from different variables within the BiB dataset and has been produced using latent class analysis [23] | (1) least deprived and most educated; (2) employed and not materially deprived; (3) employed but no access to money; (4) receiving benefits but coping; (5) most deprived |
Mother’s alcohol consumption | BiB1000 24 months | The variable describes if the mother consumed alcohol after giving birth at any point in time and does not consider frequency or quantity. | (1) yes; (2) no |
Mother’s age at birth | BiB 1000 | The variable indicates the mother’s age at birth in months | (1) under 25; (2) between 25 and 29.9; (3) 30 and above |
Child breastfeeding | BiB1000 6 months | The variable describes if the child was breastfed at any point after giving birth. It does not give information on the exclusivity or frequency of breastfeeding. | (1) yes; (2) no |
Parental psychological wellbeing | BiB1000 18 months | The determinants assess somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. This using the standardised GHQ-28 questionnaire [24]. | The higher the score, the more psychological distress |
Caregiver’s feeding style | BiB1000 24 months | Identifies four parental feeding styles: authoritative (high responsiveness, high demandingness), authoritarian (low responsiveness, high demandingness); indulgent (high responsiveness, low demandingness) and uninvolved (low responsiveness, low demandingness). This was measured based on the questionnaire and cut of points by Hughes and colleagues [25]. | (1) authoritarian; (2) authoritative; (3) indulgent; (4) uninvolved |
Child-Level Determinants | |||
Ethnicity | Baseline and other BiB sources | This variable describes the ethnicity of the child | (1) White British; (2) Pakistani; (3) Other |
Physical activity of the child | BiB1000 24 months | The variable describes how often the child has been taken somewhere to be physically active | (1) never; (2) once a month up to once a week; (3) twice a week up to 7 times a week |
Sex | Various BiB sources | Sex of the child | (1) male; (2) female |
Daily TV hours during weekday of the child | BiB1000 24 months | The variable indicates the hours of TV the child watches during a 24-hr weekday | (1) none; (2) up to 1 h; (3) 1–2 h; (4) 2–3 h; (5) more than 3 h |
Frequency of drinking sugar-sweetened drinks child | BiB1000 36 months | The variable describes the frequency of drinking sugar- sweetened beverages over the period of 2–3 months | (1) very low consumption of sugary drinks; (2) medium to high consumption of sugary drinks |
Emotional and behavioural wellbeing of the child | BiB1000 36 months | The score of the validated strength and difficulties questionnaire [26] indicates the results of a brief emotional and behavioural screening of the child. A higher score indicates lower levels of emotional and behavioural wellbeing | (1) close to average; (2) slightly raised; (3) high; (4) very high |
Hours of sleep child/day | BiB1000 24 months | The score indicates the hours a child sleeps per 24 h | (1) less than 10 h per 24 h; (2) between 10–12 h per 24 h; (3) 12.5–14 h per 24 h; (4) more than 14 h per 24 h |
Outcomes | |||
Dental caries | GA dataset and oral health survey of 5-year-old children 2014–2015 | The categories indicate if a child has experienced dental caries or if the teeth are caries free | Count ranging from 0–21 teeth affected by dental caries |
Weight status | Various BiB sources | The variable indicates the weight status in relation to height and age of children (WHO standards) | (1) severe thinness; (2) thinness; (3) normal weight; (4) overweight; (5) obese |
Dental GA (n = 136) | Oral Health Survey of 5-Year-Old Children 2014–2015 (n = 35) | Total (n = 171) | |
---|---|---|---|
Age children (years), mean (range) | 5.7 (2.3–6.6) | 5.4 (4–6) | 5.6 (2.3–6.6) |
Weight status of child, N (%) | |||
Severe thinness | 0 | 0 | 0 |
Thinness | 6 (4.5%) | 0 | 6 (3.5%) |
Normal weight | 99 (73%) | 26 (74.3%) | 125 (73.1%) |
Overweight | 25 (18%) | 8 (22.8%) | 33 (19.3%) |
Obese | 6 (4.5%) | 1 (2.9%) | 7 (4.1%) |
dmft: mean (SD) range | 9.1 (3.9) 2–21 | 0.9 (1.8) 0–8 | mean: 7.4 |
Sex, N (%) | |||
Male | 68 (50%) | 11 (31.4%) | 79 (46.2%) |
Female | 68 (50%) | 24 (65.6%) | 92 (53.8%) |
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Uerlich, M.F.; Baker, S.R.; Day, P.F.; Brown, L.; Vettore, M.V. Common Determinants of Dental Caries and Obesity in Children: A Multi-Ethnic Nested Birth Cohort Study in the United Kingdom. Int. J. Environ. Res. Public Health 2021, 18, 12561. https://doi.org/10.3390/ijerph182312561
Uerlich MF, Baker SR, Day PF, Brown L, Vettore MV. Common Determinants of Dental Caries and Obesity in Children: A Multi-Ethnic Nested Birth Cohort Study in the United Kingdom. International Journal of Environmental Research and Public Health. 2021; 18(23):12561. https://doi.org/10.3390/ijerph182312561
Chicago/Turabian StyleUerlich, Magdalena F., Sarah R. Baker, Peter F. Day, Lucy Brown, and Mario V. Vettore. 2021. "Common Determinants of Dental Caries and Obesity in Children: A Multi-Ethnic Nested Birth Cohort Study in the United Kingdom" International Journal of Environmental Research and Public Health 18, no. 23: 12561. https://doi.org/10.3390/ijerph182312561