The Healthy Eating Index and coronal dental caries in US adults: National Health and Nutrition Examination Survey 2011-2014

Abstract

Background: The purpose of this cross-sectional study was to determine if Healthy Eating Index (HEI-2015) scores are associated with coronal caries and the odds of untreated coronal caries in adults 20 years and older.

Methods: Data on decayed, missing, and filled teeth (DMFT), untreated coronal caries, and HEI-2015 scores were obtained from 7,751 adults who completed a dental examination and two 24-hour dietary recalls in National Health and Nutrition Examination Survey cycles 2011-2012 and 2013-2014. HEI-2015 scores were categorized into quintiles, with HEI-2015 quintile 1 scores indicating the least compliance with 2015-2020 Dietary Guidelines for Americans. The authors used multivariable linear regression to assess associations of HEI-2015 with DMFT and logistic regression for associations with untreated coronal caries. All regression models were controlled for age, sex, race or ethnicity, current cigarette use, family income to poverty threshold ratio, last dental visit, education, and whether participants were ever told they had a heart attack.

Results: Relative to HEI-2015 quintile 1, the adjusted odds of any untreated coronal caries were quintile 5 (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.46 to 0.80), quintile 4 (OR, 0.66; 95% CI, 0.53 to 0.84), quintile 3 (OR, 0.76; 95% CI, 0.56 to 1.04), and quintile 2 (OR, 0.93; 95% CI, 0.66 to 1.31). Participants who met the recommendations for the total fruits, whole fruits, greens and beans, and added sugars components of the HEI-2015 score were less likely to have untreated coronal caries than those who did not meet the recommendations. Overall, mean coronal DMFT also decreased as HEI-2015 scores increased, but trends were not consistent in all racial or ethnic groups.

Conclusions and practical implications: Greater compliance with the Dietary Guidelines for Americans is associated with lower prevalence and the odds of untreated caries in adults. Dietary counseling for caries prevention by dental professionals should incorporate comprehensive dietary guidelines that are consistent with those intended for enhancing overall health and reducing the risk of developing common systemic diseases.

Keywords: Dental caries; NHANES; diet quality; dietary guidelines for Americans; nutrition.

Figure 1

Mean (±2 se) coronal DMFT among US adults ≥ 20 years, by quintile of Healthy Eating Index (HEI-2015) score and race/ethnicity, NHANES 2011–2012 and 2013–2014. Means are adjusted for age, gender, current cigarette use (yes/no), family income-to-poverty threshold ratio, education (11^th grade or less, high school graduate/GED, or some college/AA degree /college graduate), last dental visit (within the past year, >1 year but ≤3 years, or >3 years), and ever told had a heart attack (yes/no). P values for linear trend across quintiles were as follows: Mexican-Americans, P=0.07; Other Hispanic, P=0.64; non-Hispanic White, P<0.01; non-Hispanic Black, P<0.01; non-Hispanic Asian, P<0.001; Other-including Multiracial, P=0.32.