ASSOCIAÇÃO ENTRE CONSUMO DE ALIMENTOS SEGUNDO O GRAU DE PROCESSAMENTO E CÁRIE DENTÁRIA EM ADOLESCENTES DA COORTE BRISA

Abstract

Introduction: Dental caries is the most prevalent oral disease worldwide and presents a high burden already in early adolescence, accounting for more than 2 billion cases in permanent teeth, according to data from the Global Burden of Disease. Although it is multifactorial, contemporary dietary patterns have been identified as a potential risk factor in the etiology of dental caries. Objective: To investigate the association between food consumption according to the level of processing and dental caries among adolescents from the BRISA cohort. Methods: This is a cross-sectional study using data from the BRISA birth cohort in São Luís, Maranhão, Brazil. Participants (n = 1,665) were evaluated in the second follow-up (11–13 years of age), during which sociodemographic information, lifestyle habits, dietary intake, and oral examinations were collected. Theoretical models were tested to assess the association between food consumption according to processing level (percentage in grams) and dental caries. In the first model, the exposure variable was the consumption of unprocessed or minimally processed foods (UMPF); in the second, the consumption of ultra-processed foods (UPF); and in the third, the combined consumption of processed foods + UPF (sensitivity analysis). The outcome (dental caries) was treated as a dichotomous variable. Adjustment variables included a latent socioeconomic status (SES); sex; adolescent age; mother’s skin color; sleep duration (insufficient: < 8 hours/night; sufficient: ≥ 8 hours/night); and screen time (adequate: ≤ 2 hours/day; high: > 2 hours/day). In the theoretical models, SES was considered a more distal determinant linked to both the exposure (dietary consumption) and the outcome (dental caries). The exposure factor was directly associated with the outcome and acted as a mediator between SES and caries, while adjustment variables were linked to both exposure and outcome. Data analysis was performed using R version 4.5.0 and RStudio. Descriptive analysis included absolute and relative frequencies, as well as measures of central tendency and dispersion. Structural equation modeling was used to analyze associations between exposure variables and the outcome, adopting a 95% significance level. The study complied with the recommendations of Resolution 340/2004 of the Brazilian National Health Council. Results: Among the 1,665 adolescents, 53.3% were male and 61.6% were 12 years old; most had mothers with brown or Black skin color (86.3%). The prevalence of dental caries was 34%, and it was higher among females (p = 0.008). Analysis of individual dietary intake showed a mean total energy intake of 1,702 kcal/day (SD: 261.639), with 30.8% coming from UPF. A positive and significant association was observed between UPF consumption and dental caries (β = 0.009; p = 0.033), while a negative and significant association was found between UMPF consumption and caries (β = −0.095; p = 0.045). The latent SES variable showed a significant direct effect on both dietary consumption and dental caries in all models, whereas adjustment variables did not show significant associations. Conclusion: The study found a high contribution of UPF to adolescents’ diets and a direct association with dental caries, as well as a protective effect of UMPF consumption. Additionally, socioeconomic status was associated with dental caries in all models. These findings reinforce the role of dietary patterns and socioeconomic conditions in the occurrence of dental caries in adolescents, highlighting the need for strategies aimed at promoting healthy eating as a central axis for caries prevention in this age group, as well as investments to improve population socioeconomic conditions.