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. 2025 Mar 25;184(4):268.
doi: 10.1007/s00431-025-06093-w.

Introduction of fruit juice and sugar-sweetened beverages before 6 months of age and early childhood caries at 3.5 years: the ELFE cohort study

Joséphine Kerguen  1   2 , Cathy Nabet  3   4 , Sylvie Azogui-Lévy  5   6 , Anne-Laure Bonnet  7   8 , Sibylle Vital  8   9 , Véronique Pierrat  10   11 , Monique Kaminski  10 , Marie-Noelle Dufourg  12 , Alice Germa  10   7
Affiliations

Introduction of fruit juice and sugar-sweetened beverages before 6 months of age and early childhood caries at 3.5 years: the ELFE cohort study

Joséphine Kerguen et al. Eur J Pediatr. .

Abstract

The aim of this study was to investigate the relationships between the introduction of fruit juice or sugar-sweetened beverages (SSBs) before the age of 6 months and the presence of early childhood caries (ECC) at 3.5 years of age. The study is based on data from the population-based nationwide prospective cohort study ELFE (French Longitudinal Study of Children). Children were recruited at birth in 2011 in France. Detailed data on the children's diets, as well as socio-economic characteristics and dental caries at 3.5 years, were prospectively collected through online questionnaires and telephone interviews of the parents. The primary outcome was the presence of ECC reported by the parents at 3.5 years. The main exposure was the introduction of fruit juice or SSBs before the age of 6 months into the child's diet. Among the 10,921 children included, 1955 (19.5%) were exposed to fruit juice or SSBs before 6 months of age and 229 (3.0%) had ECC; 53 (4.7%) of exposed children and 176 (2.5%) of those not exposed had ECC at 3.5 years of age. Based on multivariable analysis, introduction of fruit juice or SSBs before 6 months of age was associated with ECC at 3.5 years (adjusted OR = 1.5, 95% CI [1.1, 2.2]).

Conclusion: This study indicates that early introduction of fruit juice or SBBs is associated with an increased risk of developing ECC, highlighting the need for early prevention by childhood professionals and nationwide prevention campaigns.

What is known: • Consumption of SSBs is a well-known risk factor for dental caries in children, yet fruit juices still culturally maintain a healthy image. • Limited data on ECC risk factors in children under 4 years have been published.

What is new: • The very early introduction of fruit juices or SSBs into a child's diet is later associated with ECC at 3.5 years. • This study is the first to investigate complementary feeding in relation to ECC before the age of 4 using a nationwide population-based design.

Keywords: Child; Cohort studies; Dental caries; ECC; Risk factors; Sugar-sweetened beverages.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The ELFE study was approved by the National advisory committee on information processing in health research Information (CCTIRS: Comité Consultatif sur le Traitement des Informations pour la Recherche en Santé), the National Data Protection Authority (CNIL: Commission Nationale Informatique et Libertés), and the National Statistics Council (CNIS: Conseil National de l’Information Statistique). The study was conducted in accordance with the Declaration of Helsinki. All participating parents provided written consent for their own and their child’s participation. Competing interests: The authors declare no competing interests.

References

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