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Early Childhood Junk Food Consumption, Severe Dental Caries, and Undernutrition: A Mixed-Methods Study from Mumbai, India.

ABSTRACT: In India, globalization has caused a nutrition transition from home-cooked foods to processed sugary snacks and drinks, contributing to increased early childhood caries (ECC). This mixed-methods study describes risk factors for ECC and associations with undernutrition in low-income communities in Mumbai. Interviews with mothers of 959 children, ages six-months through six-years, addressed maternal-child nutrition and oral health, and children received dental exams and anthropometric assessments. Focus groups with community health workers and mothers explored experiences and perceptions of oral health, nutrition, and ECC. Descriptive and logistic regression analyses of quantitative data, and content analysis of qualitative data were performed. Eighty percent of children lived 5 min from a junk-food store, over 50% consumed junk-food and sugary tea daily, 50% experienced ECC, 19% had severe deep tooth decay, 27% experienced mouth pain, and 56% experienced chronic and/or acute malnutrition. In children ages 3-6, each additional tooth with deep decay was associated with increased odds of undernutrition (Odds Ratio [OR] 1.10, Confidence Interval [CI] 1.02-1.21). Focus groups identified the junk-food environment, busy family life, and limited dental care as contributors to ECC. Policy interventions include limits on junk-food marketing and incorporating oral health services and counseling on junk-food/sugary drinks into maternal-child health programs.

SUBMITTER: Athavale P

PROVIDER: S-EPMC7699964 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Early Childhood Junk Food Consumption, Severe Dental Caries, and Undernutrition: A Mixed-Methods Study from Mumbai, India.

Athavale Priyanka P Khadka Nehaa N Roy Shampa S Mukherjee Piyasree P Chandra Mohan Deepika D Turton Bathsheba Bethy BB Sokal-Gutierrez Karen K

International journal of environmental research and public health 20201120 22

In India, globalization has caused a nutrition transition from home-cooked foods to processed sugary snacks and drinks, contributing to increased early childhood caries (ECC). This mixed-methods study describes risk factors for ECC and associations with undernutrition in low-income communities in Mumbai. Interviews with mothers of 959 children, ages six-months through six-years, addressed maternal-child nutrition and oral health, and children received dental exams and anthropometric assessments. ...[more]

PMID: 33233797

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Project description:BackgroundTrends in junk food consumption, a risk for obesity, are not well established.ObjectivesWe examined national trends in types of junk food (excluding beverages) and their sources (grocery, restaurants, schools, etc.), overall and in population subgroups.MethodsWe assessed 29,970 children (aged 2-19 y) and 44,501 adults (aged ≥20 y) with 24-h dietary recall data from 9 NHANES cycles (2001-2002 to 2017-2018). Trends in junk food were assessed over time using 1-d values for individuals with single recalls and 2-d means for others.ResultsFrom 2001 to 2018, percent energy (%E) from junk food remained stable for children (from 18.1% to 17.5%, P-trend = 0.25) and decreased for adults (14.1% to 13.0%, P-trend = 0.002). Among children, increases occurred in %E from crackers (1.19% to 1.35%) and snack/meal bars (0.38% to 0.69%) and decreases in candy (2.58% to 1.96%) and other desserts (3.11% to 2.48%) (all P-trends < 0.01). Among adults, increases occurred in snack/meal bars (0.31% to 0.78%, P-trend < 0.001) and decreases in candy (1.97% to 1.55%; P-trend < 0.001), sweet bakery products (5.52% to 4.98%; P-trend = 0.04), and other desserts (2.19% to 1.86%; P-trend = 0.001). In 2017-2018, grocery stores provided the largest proportion of junk food (72.7% for children, 77.1% for adults), followed by other sources (13.1%, 12.1%), restaurants (8.05%, 9.11%), schools (4.86%), and worksites (1.99%). In both children and adults, junk food intake was higher among non-Hispanic white and black Americans compared with Mexican Americans, among those with higher compared with lower education, among women compared with men, and among older compared with younger adults. In sensitivity analyses using only 1-d recalls, mean junk food intake each cycle was ∼0.8-1.0 and 0.3-0.4%E units higher in children and adults, respectively, with otherwise similar trends and subgroup differences over time.ConclusionsFrom 2001 to 2018, %E from junk food represented nearly 1 in 5 calories among children, without change, and nearly 1 in 7 calories, with modest decrease, among adults, with disparities in subgroups.

Project description:Background: Young children living in urban slums are vulnerable to malnutrition and subsequently poor health outcomes, but data on the correlates of stunting, underweight, wasting, and anemia specifically among 10-18 month-old children in India remain limited. Objective: In this analysis, we sought to describe the prevalence of and examine correlates for different markers of undernutrition, including stunting, underweight, and anemia among 10-18 month-old children living in urban slums, an understudied vulnerable group. Methods: Children and their mothers (n = 323) were screened for anthropometry, demographics, and complete blood counts for hemoglobin concentration between March and November 2017 (Clinicaltrials.gov ID: NCT02233764). Correlates included child and mother's age, sex, birth order, birth weight, illness episodes, hemoglobin concentration, family income, maternal height, and maternal education level. Risk ratios (RR, 95% CI) for binary outcomes (stunting, underweight, wasting and anemia) and mean differences (β, 95% CI) for continuous outcomes (anthropometric Z-scores, hemoglobin concentration) were calculated using multivariate binomial and linear regression (SAS 9.4). Results: The prevalence of stunting was 31.2%, underweight 25.1%, wasting (9.0%), and anemia (76%) among all children. Male children had a higher prevalence of poor growth indices and lower anthropometric Z-scores than females. Male sex, low birthweight, shorter maternal height, report of ≥1 episodes of illness within the past month, older maternal age, and birth order ≥2 were also associated with poor growth and anemia in multivariate models. Correlates of undernutrition were different among females and males. Female children had a 40% (20, 60%) higher risk of anemia associated with diarrhea, and male children who were firstborn had a 20% (0, 70%) lower risk of anemia. Conclusions: These results show that poor growth and anemia among young children is prevalent in urban slums of Mumbai, and that sex of the child may play an important role in informing interventions to address undernutrition.

Dataset Information

Early Childhood Junk Food Consumption, Severe Dental Caries, and Undernutrition: A Mixed-Methods Study from Mumbai, India.

Publications

Early Childhood Junk Food Consumption, Severe Dental Caries, and Undernutrition: A Mixed-Methods Study from Mumbai, India.

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