Caries and Sugar Consumption: An Ecological Study of 85 Countries

Objective: The purpose of this study was to explore the association between national estimates for mean DMFT in 12 year old children and per capita sugar consumption in 85 countries.

Method: An ecological study design was used to test the relationship between national estimates for dental caries level (mean DMFT) and per capita sugar consumption, stratified for Gross national income and income inequality. National estimates for mean DMFT for 12 year-old children and per capita sugar consumption were obtained from the WHO Oral Health Area Profile Programme (CAPP) and United Nations Food and Agricultural Organization (UNFAO) respectively. World Bank’s data on Gross National Income- purchasing Power Party (GNI-PPP) and Gini coefficient was used to stratify countries for analysis. Simple linear regression analysis was done to estimate the associations between dental caries levels (mean DMFT) and per capita sugar consumption. 

Result: Finally, estimates for 85 countries were analyzed. For lower income countries group mean DMFT was 2.0 (SD+1.20). However, higher income countries had slightly lower mean of 1.6 (SD+1.06). Higher income countries had higher mean sugar consumption (40.96+ SD=12.63) than lower income countries (28.18+ SD= 15.63).  Simple linear regression analysis showed per capita sugar consumption as a good predictor for dental caries in high income (B=0.03,p=0.01, CI=0.007-0.53, R²=0.40) and low income (B=-0.027,p=0.05,CI=-0.053-0.00, R²=0.39) country groups. This association between mean DMFT and per capita sugar consumption in low and high inequality country groups was weak and not significant.

Conclusion: Results show significant increase in the caries level with per capita sugar consumption in high income countries but this relationship gets reverse in low income countries where increase in per capita sugar consumption associated with decrease in caries level. This relationship of sugar consumption, dental caries and national income should be explored with consideration of other predictors of dental caries.