Non-Cochrane · aetiology · PM38146474
The bi-directional relationship between growth stunting and early childhood caries: a rapid review.
Aulia Refine Nissa, Indriyanti Ratna, Setiawan Arlette Suzy · Frontiers in public health · 2023 · PubMed · doi:10.3389/fpubh.2023.1234893
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
13
current version
GRADE rated
0
No studies
0
Included studies
9
linked below
No studies 0 · 0%Ungraded 13 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children aged 0-5 years (early childhood) | Children aged 6 months-6 years (9 studies; sample sizes 82-1,575) |
| Intervention | Growth stunting as exposure (bidirectional: stunting or ECC treated as the exposure) | Growth stunting; and early childhood/severe caries (bidirectional exposures) |
| Comparison | Children without growth stunting, or without early childhood caries | Non-stunted (normal height-for-age); caries-free children |
| Outcomes | Development of early childhood caries, or growth stunting (bidirectional) | ECC (def-t/dmft) and stunting / linear growth (height-for-age z-score) |
| Study designs | Observational studies (cohort, case-control, cross-sectional) | 6 cross-sectional, 2 longitudinal, 1 quasi-experimental (9 studies) |
| Timing | Not specified (included studies published 2012-2020) | Mostly cross-sectional; longitudinal follow-up ~9.7 months (Shen), 1 year (Renggli), 2 years (Sokal-Gutierrez) |
Search date: Not specified (included studies published 2015-2020; inclusion window 2012-2020). Databases: PubMed and Scopus (abstract states 'Cochrane and PubMed'); backward and forward snowballing
Questions and results
Growth stunting (linear growth retardation, low height-for-age) vs Children without growth stunting (normal height-for-age)
Population: Children in early childhood (0-6 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early childhood caries (def-t/dmft caries experience) Folayan et al. 2019 (Nigeria; adjusted, model 3) One Nigerian cross-sectional study reported a significant adjusted association between nutritional (stunting) status and ECC (APR 0.14, 95% CI 0.03-0.69); ungraded. Source: Table 1 (row 3, Folayan et al.); Discussion · same question in other reviews | APR 0.14 [0.03, 0.69] | 1 study · 370 participants | Ungraded |
Early childhood caries (def-t/dmft caries experience) 2-year follow-up · Sokal-Gutierrez et al. 2016 (Ecuador; pre vs post intervention) A quasi-experimental Ecuadorian prevention program reduced both ECC (e.g., prevalence 53.8% to 30.3% at age 1) and malnutrition over 2 years; ungraded, no association effect estimate reported. Source: Table 1 (row 4, Sokal-Gutierrez et al.); Discussion · same question in other reviews | Pre/post ECC prevalence, dmft, and deep-caries proportion (2-year follow-up) Age 1: prevalence 53.8% to 30.3%, dmft 2.1 to 0.9; Age 2: prevalence 82% to 60%, dmft 5.3 to 3.0, deep caries 19% to 12% (pre vs post) | 1 study · 1575 participants | Ungraded |
Early childhood caries (def-t/dmft caries experience) Vieira et al. 2020 (Brazil) One Brazilian cross-sectional study found no significant association between chronic malnutrition (stunting) and caries (r=-0.091, p>0.05); ungraded. Source: Table 1 (row 2, Vieira et al.); Discussion · same question in other reviews | Correlation (r) -0.091 | 1 study · 82 participants | Ungraded |
Early childhood caries (def-t/dmft caries experience) Achmad et al. 2020 (Indonesia) In one Indonesian cross-sectional study, stunted children had a higher mean def-t caries index than normal-height children (p=0.001); ungraded. Source: Table 1 (row 1, Achmad et al.); Results 'Relationship of ECC in stunted children' · same question in other reviews | MEAN 7.37 | 1 study · 208 participants | Ungraded |
Early childhood caries / severe early childhood caries vs Caries-free children
Population: Children in early childhood (0-6 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Growth stunting / low linear growth (height-for-age z-score) Tsang et al. 2019 (Nepal) One Nepalese cross-sectional study found caries severity significantly correlated with chronic malnutrition/stunting (HAZ; p<0.0001), especially in rural children; ungraded, no effect size reported. Source: Table 1 (row 8, Tsang et al.); Discussion · same question in other reviews | The severity of child caries measured by the dmft index correlated with mouth pain and both chronic (stunting) and acute malnutrition (HAZ score) (p<0.0001). | 1 study · 836 participants | Ungraded |
Growth stunting / low linear growth (height-for-age z-score) Khanh et al. 2015 (Vietnam; pulp-involved caries) In a Vietnamese cross-sectional study, pulp-involved caries was associated with significantly lower height-for-age (mean difference 0.66, p=0.001); ungraded. Source: Table 1 (row 9, Khanh et al.); Discussion · same question in other reviews | MD 0.66 | 1 study · 593 participants | Ungraded |
Change in height-for-age z-score (adjusted model) ~9.73-month follow-up · Shen et al. 2019 (China; adjusted) The association between baseline caries and declining height-for-age persisted after adjustment (coefficient -0.02); ungraded. Source: Table 1 (row 7, Shen et al.); Results 'Stunting relationship with ECC' · same question in other reviews | Regression coefficient -0.02 [-0.04, 0.01] | 1 study · 1111 participants | Ungraded |
Growth stunting / low linear growth (height-for-age z-score) 1-year follow-up · Renggli et al. 2021 (Cambodia) In a Cambodian 1-year cohort, children with severe caries had nearly double the odds of transitioning to low height-for-age (OR 1.8, 95% CI 1.0-3.0; borderline); ungraded. Source: Table 1 (row 5, Renggli et al.); Discussion; Results 'Stunting relationship with ECC' · same question in other reviews | OR 1.8 [1.0, 3.0] | 1 study · 1307 participants | Ungraded |
Risk of malnutrition (younger children, 6 months to 6 years) Zahid et al. 2020 (Nepal; children 6 months-6 years) One Nepalese cross-sectional study found no significant association between severe ECC and malnutrition risk in children under 6 (mean difference 0.13, p=0.609); ungraded. Source: Table 1 (row 6, Zahid et al.); Discussion · same question in other reviews | MD 0.13 [-0.64, 0.38] | 1 study · 273 participants | Ungraded |
Baseline caries vs Lower baseline caries
Population: Preschool children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in height-for-age z score Mean follow-up 9.73 months · Unadjusted model The review reported an unadjusted negative association between baseline caries and change in height-for-age z score. Source: Table 1 · same question in other reviews | coefficient -0.03 [-0.04, 0.01] | 1 study · 1111 participants | Ungraded |
Pulp-involved caries vs No pulp-involved caries
Population: Children aged 1–6 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Body mass index-for-age z score Pulp-involved caries The review reported lower body mass index-for-age z scores in children with pulp-involved caries. Source: Table 1 · same question in other reviews | MD 1.18 | 1 study · 593 participants | Ungraded |
Weight-for-age z score Pulp-involved caries The review reported lower weight-for-age z scores in children with pulp-involved caries. Source: Table 1 · same question in other reviews | MD 1.17 | 1 study · 593 participants | Ungraded |
Mouth pain vs No mouth pain
Population: Children aged 1–6 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Body mass index-for-age z score Mouth pain The review reported lower body mass index-for-age z scores in children with mouth pain. Source: Table 1 · same question in other reviews | MD 0.29 | 1 study · 593 participants | Ungraded |
Included primary studies 9
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Folayan et al. 2019 Association between early childhood caries and malnutrition in a sub-urban population in Nigeria. PMID:31722683 | 1 other review | Early childhood caries (def-t/dmft caries experience) | not extracted yet | not extracted yet |
| Renggli et al. 2021 Stunting Malnutrition Associated with Severe Tooth Decay in Cambodian Toddlers. PMID:33498508 | 1 other review | Risk of malnutrition (younger children, 6 months to 6 years); PM38146474-P3-O1 | not extracted yet | not extracted yet |
| Achmad et al. 2020 matched by author and year (probable) | this review only | Early childhood caries (def-t/dmft caries experience) | not extracted yet | not extracted yet |
| Khanh et al. 2015 Early Childhood Caries, Mouth Pain, and Nutritional Threats in Vietnam. PMID:26469655 | this review only | Risk of malnutrition (younger children, 6 months to 6 years); PM38146474-P6-O1 | not extracted yet | not extracted yet |
| Shen et al. 2019 The bidirectional relationship between weight, height and dental caries among preschool children in China. PMID:31039199 | this review only | Risk of malnutrition (younger children, 6 months to 6 years); Change in height-for-age z score | not extracted yet | not extracted yet |
| Sokal-Gutierrez et al. 2016 matched by author and year (probable) | this review only | Early childhood caries (def-t/dmft caries experience) | not extracted yet | not extracted yet |
| Tsang et al. 2019 Early Childhood Oral Health and Nutrition in Urban and Rural Nepal. PMID:31295932 | this review only | Risk of malnutrition (younger children, 6 months to 6 years) | not extracted yet | not extracted yet |
| Vieira et al. 2020 Chronic malnutrition and oral health status in children aged 1 to 5 years: An observational study. PMID:32358344 | this review only | Early childhood caries (def-t/dmft caries experience); Risk of malnutrition (younger children, 6 months to 6 years) | not extracted yet | not extracted yet |
| Zahid et al. 2020 Associations between Child Snack and Beverage Consumption, Severe Dental Caries, and Malnutrition in Nepal. PMID:33126647 | this review only | Risk of malnutrition (younger children, 6 months to 6 years); PM38146474-P4-O1 | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).
| Review | Shared studies | Jaccard |
|---|---|---|
| Individual, Family, and Socioeconomic Contributors to Dental Caries in Children from Low- and Middle-Income Countries. (2022) | 2 | 0.11 |