Supplementary Material for: Household food insecurity and dental caries experience in adolescents from southern Brazil

Objective: To describe the association between household food insecurity and the prevalence of cavitated dental caries lesions in adolescents. Material and methods: This is a cross-sectional study nested within a 13-year cohort study that began in 2010 with a representative sample of preschool children aged 1 to 5 years from Santa Maria, southern Brazil. Participants were followed up in several phases of the cohort study, and this analysis used data from the most recent reevaluation, when individuals were aged between 14 and 18 years. Dental caries was assessed using the Worl Health Organization (WHO) criteria (cavitated caries lesions). Household food insecurity was measured using the Brazilian Food Insecurity Scale (EBIA), considering households with individuals under 18 years of age. The association between the presence of different levels of household food insecurity and caries experience was analyzed using adjusted Poisson regression models. Results are presented as Mean Ratios (MR) with 95% Confidence Intervals (95% CI). Results: Of the 406 adolescents assessed, 300 parents or guardians (73.9%) completed the food and nutrition insecurity questionnaire. Approximately 56.0% (95%CI 50.2%-61.7%) of households experienced some degree of food and nutrition insecurity. The prevalence of cavitated dental caries lesions was 38.0% (95%CI 32.5%-43.8%). Adolescents living in households with mild or moderate food insecurity had on average 62% higher mean surfaces with cavitated dental caries (MR 1.62;95%CI 1.28–2.06) than their counterparts without food insecurity. The presence of severe food insecurity was also associated with about twice the mean surface with cavitated dental caries (MR 1.92; 95%CI 1.35–2.73). Conclusion: In addition to the nutritional consequences, food insecurity compromises oral health and should be a priority to reduce social inequalities in oral diseases.

研究目的：探讨青少年家庭粮食不安全与龋洞性病损（cavitated dental caries lesions）患病率之间的关联。

材料与方法：本研究为一项嵌套于2010年启动的13年队列研究的横断面研究，初始样本取自巴西南部圣玛丽亚市1至5岁学龄前儿童的代表性队列。研究对象在队列研究的多个阶段接受随访，本次分析采用最新一次复查的数据，此时研究对象年龄为14至18岁。龋齿评估采用世界卫生组织（World Health Organization, WHO）诊断标准（龋洞性病损）。家庭粮食不安全情况采用巴西粮食不安全量表（Brazilian Food Insecurity Scale, EBIA）进行测量，研究覆盖家中有18岁以下成员的家庭。本研究采用校正泊松回归模型分析不同程度家庭粮食不安全与龋病患病情况的关联，结果以均比（Mean Ratios, MR）及95%置信区间（95% Confidence Intervals, 95% CI）呈现。

结果：本次共评估406名青少年，其中300名家长或监护人（占比73.9%）完成了粮食与营养不安全调查问卷。约56.0%（95%CI 50.2%~61.7%）的家庭存在不同程度的粮食与营养不安全情况。龋洞性病损的患病率为38.0%（95%CI 32.5%~43.8%）。与无粮食不安全的青少年相比，居住在轻度或中度粮食不安全家庭的青少年，其龋洞性病损的平均受累牙面数高出62%（MR=1.62；95%CI 1.28~2.06）。重度粮食不安全也与龋洞性病损平均受累牙面数增加约一倍相关（MR=1.92；95%CI 1.35~2.73）。

结论：除营养相关健康损害外，粮食不安全还会损害口腔健康，应将其作为降低口腔疾病社会不平等性的优先事项。