Quantitative relationship between free sugars intake and early childhood caries among preschoolers in Sri Lanka.

Introduction: Before implementing the WHO sugar recommendations, more studies are needed concerning its application to given contexts.

Objective: To identify free sugars intake levels associated with a minimum caries risk in primary dentition METHODS: Using probability proportionate to size technique and cluster sampling, 813 children aged 4-5-years were selected from preschools in the Colombo district, Sri Lanka. A 67-item quantitative food frequency questionnaire was developed and validated to evaluate free sugars intake. Dental caries was assessed clinically using dmft index. For the selection of cut-off values for free sugars intake levels, ROC curves were used.

Results: The median (IQR) amount of free sugars intake was 57.9 (33.2 -95.8) g/day or 21.1 % (12.5 %-35.9 %) of total energy requirement, with a frequency of 4.0 (2.7-6.1) times/day. Dental caries prevalence was 42.9 % (n = 349). Among all possible risk factors, free sugars intake as a percentage of total energy requirement (p < 0.001) and frequency of free sugars intake (p < 0.001) were significantly associated with the presence of dental caries. The percentage of free sugars that discriminates against a possible highest number of children with dental caries (99 %) was determined as 4 %, of the total energy requirement of a child, which is approximately 12 g/day (3 level teaspoons/day). Sugar intake once a day has a 97 % sensitivity in identifying children with dental caries. These cut-off values do not differ among the group who brush twice a day with fluoridated toothpaste.

Conclusion: For optimal caries prevention, children's free sugar intake should limit to <5 % of their total energy intake or consume less frequently than once daily.

Clinical Significance: This study provides facts that policy makers and dental clinicians can use for dietary recommendations in Sri Lanka, which they will include in the next revision of the booklet, "Uniform Oral Health Messages for Sri Lankans". Additionally, health professionals and health information materials will disseminate these recommendations to the public.