Supplementary information files for Impact of unhealthy food and beverage consumption on children’s risk of dental caries: a systematic review

© the Authors, CC-BY 4.0Supplementary files for article Impact of unhealthy food and beverage consumption on children’s risk of dental caries: a systematic reviewContext The impact of unhealthy foods and beverages, namely those high in sugar, salt, and saturated or trans fats, has been studied extensively in relation to weight, body composition, and noncommunicable diseases, but less so in relation to the risk of dental caries. Few previous reviews have examined the evidence from all countries globally. ObjectiveA systematic review was conducted to assess the impact of unhealthy food and beverage consumption on the risk of dental caries in children aged ≤10 years, commissioned by the World Health Organization to inform updated complementary feeding recommendations. Data Sources Systematic searches were conducted in the PubMed, Cochrane, and Embase databases for articles meeting the inclusion criteria dating from January 1971 to March 2022; supplementary searches were undertaken for articles from that period to June 2022. Data Extraction Unhealthy foods and beverages were identified using nutrient- and food-based approaches. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I). Data Analysis A total of 30 023 unique citations were screened, yielding 37 studies for inclusion. Studies were conducted in high-income (n = 23 [62.2%]) or middle-income countries (n = 14 [37.8%]). Evidence synthesis was performed narratively, stratified by age (0 years to <2 years, 2 years to <5 years, and 5 years to ≤10 years) and exposure (unhealthy foods and unhealthy beverages). The heterogeneity of the exposures and comparators across studies was high. Almost all studies (n = 34) reported positive associations between the consumption of sugar-sweetened beverages or foods high in free sugars and dental caries. However, 67.6% of studies were assessed as having serious risk of bias. Conclusion The evidence indicates that the consumption of unhealthy food and beverages in children ≤10 years appears to increase the risk of dental caries. Further longitudinal studies with high-quality dietary assessments, including studies in low-income countries and children aged >5 years at baseline, are recommended in order to build a more robust evidence base for use in the development of policy recommendations.

© 作者，CC-BY 4.0许可 本论文《不健康食品饮料摄入对儿童龋齿风险的影响：一项系统综述》的补充文件。
研究背景：高糖、高盐以及富含饱和脂肪或反式脂肪的不健康食品饮料，其对体重、身体成分与非传染性疾病的影响已被广泛研究，但针对其与儿童龋齿风险的关联则关注度不足；既往鲜有综述纳入全球范围内所有国家的相关证据。
研究目的：受世界卫生组织（World Health Organization, WHO）委托开展本系统综述，旨在评估≤10岁儿童不健康食品饮料摄入与龋齿风险的关联，为更新婴幼儿辅食喂养建议提供依据。
数据来源：于PubMed、Cochrane及Embase数据库开展系统检索，筛选1971年1月至2022年3月期间符合纳入标准的文献；同时补充检索了该时段内2022年3月至6月的相关文献。
数据提取：采用营养分类与食物分类两种方式界定不健康食品饮料；使用非随机干预研究偏倚风险工具（Risk Of Bias In Non-randomized Studies of Interventions, ROBINS-I）评估研究偏倚风险。
数据分析：共筛选出30023条独立引用文献，最终纳入37项研究。研究开展地涵盖高收入国家（n=23，占比62.2%）与中等收入国家（n=14，占比37.8%）。采用叙述性综合方法开展证据整合，按年龄分层（0岁至<2岁、2岁至<5岁、5岁至≤10岁）与暴露因素（不健康食品、不健康饮料）进行亚组分析。各研究间暴露因素与对照设置异质性较高。其中34项研究均报道了含糖饮料或高游离糖食品摄入与龋齿风险呈正相关。然而，67.6%的研究被评估为存在严重偏倚风险。
研究结论：现有证据表明，≤10岁儿童不健康食品饮料摄入会增加龋齿风险。建议未来开展更多高质量膳食评估的纵向研究，包括低收入国家的相关研究以及基线年龄>5岁儿童的研究，以构建更严谨的证据体系，用于制定相关政策建议。