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 本文附属补充材料：《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》

研究背景：不健康食品与饮料，即高糖、高盐、饱和脂肪或反式脂肪含量的食品与饮料，其对体重、身体组成及非传染性疾病的影响已得到广泛研究，但针对其与龋齿风险的关联研究相对匮乏；既往鲜有综述能够涵盖全球所有国家的相关证据。

研究目的：受世界卫生组织（World Health Organization）委托，本系统综述旨在评估≤10岁儿童摄入不健康食品与饮料对龋齿风险的影响，以期为更新辅食喂养建议提供科学依据。

数据来源：在PubMed、Cochrane、Embase数据库中，针对1971年1月至2022年3月期间符合纳入标准的文献开展系统检索；同时补充检索了该时间段至2022年6月的相关文献。

数据提取：采用营养导向与食品导向两种方法识别不健康食品与饮料；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条独立引文，最终纳入37项研究。这些研究分别在高收入国家（n=23，占比62.2%）与中等收入国家（n=14，占比37.8%）开展。研究采用叙述性合成方法进行证据整合，并按年龄分层（0~<2岁、2~<5岁、5~≤10岁）与暴露因素（不健康食品、不健康饮料）开展亚组分析。纳入研究的暴露因素与对照设置异质性较高。几乎所有研究（n=34）均报告，含糖饮料或游离糖含量高的食品摄入与龋齿风险呈正相关。然而，67.6%的研究被评定为存在严重偏倚风险。

研究结论：现有证据表明，≤10岁儿童摄入不健康食品与饮料可能会升高龋齿风险。建议未来开展高质量膳食评估的纵向研究，包括在低收入国家开展的相关研究，以及针对基线年龄>5岁儿童的研究，以构建更坚实的证据基础，用于制定政策建议。