Sugar Intake and Dental Caries in Adolescents Under Household Food Insecurity: A Counterfactual Analysis

Purpose To evaluate the association between sugar consumption and occurrence of dental caries according to the level of food and nutritional insecurity (FNI) at home. Methods Cross-sectional study nested in a population-based cohort that began in 2010 with Brazilian preschoolers. Data were from the last wave, with adolescents aged 14–18 years. Dental caries were assessed using the International Caries Detection and Assessment System (ICDAS), considering the number of cavitated teeth. FNI was measured with the Brazilian Food Insecurity Scale (EBIA). Sugar consumption was categorized by self-reported frequency of cariogenic food intake. Demographic and socioeconomic variables were collected as confounders. Associations were estimated using Poisson regression, overall and stratified by FNI status, and presented as Mean Ratios (MR) with 95% confidence intervals (CI). A non-linear Blinder-Oaxaca decomposition was applied to explore the FNI impact. Results The sample comprised 406 adolescents. After adjustment, daily sugar consumption was associated with more cavitated lesions (MR 2.02; 95% CI 1.46–2.81). In the stratified analysis, the association was stronger among those with FNI (MR 4.88; 95% CI 1.99–11.96), but not significant in food-secure adolescents (MR 1.18; 95% CI 0.75–1.86). The decomposition showed a 95% difference in caries levels between sugar intake groups; 16% was explained by observed variables mainly household income (9.5%) and FNI (6.5%) and 72% by unmeasured factors. Conclusion High sugar consumption in FNI adolescents is associated with higher rates of cavitated carious lesions, reinforcing the need for policies integrating dietary habits and food security to improve oral health outcomes.