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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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ORIGINAL ARTICLE
Year : 2005  |  Volume : 23  |  Issue : 4  |  Page : 165-167
 

Sugar consumption pattern of 13-year-old school children in Belgaum city, Karnataka


Department of Preventive and Community Dentistry, KLES Institute of Dental Sciences, Belgaum, Karnataka, India

Correspondence Address:
P P Hegde
392, M.G. Road,Tilakwadi, Belgaum - 590006,Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.19002

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   Abstract 

To determine the sugar consumption pattern of the school children in Belgaum city and to organize for a diet-counseling program. Easy availability of sugar containing food and high consumption of these sweets if continued unabated, the dental caries among children would become a major public health problem. In this instance, Dietary counseling can be just appropriate to inhibit the carious process. 342 school children aged 13 years, from four schools in Belgaum city participated in the study. The pattern of sugar consumption was assessed using a 4-day diet diary. Analysis was done according to the method described by Nizel and Papas (Nutrition in clinical dentistry, 1989, 277) and the variables were: the sweet score, At meal sugar exposure (AMSE), Between meal sugar exposure (BMSE) and Total sugar exposure (TSE). The mean, standard deviation and/or frequency were calculated for all variables. Student's t-test was used to statistically analyze the gender difference. The mean + SD of the recorded variables were: sweet score 31 + 12.78/day, AMSE 0.88 + 0.33/day, BMSE 3.95 + 0.87/day, and TSE 4.83 + 0.96/day. No statistical significant gender difference with respect to the variables was observed. 'Tell Show And Do' Diet counseling session will perhaps have a greater impact as compared to the most common strategy of simply exhorting the children to eat less sugar.


Keywords: Diet counseling, Schoolchildren, Sugar, Sucrose, Sugar exposure, Sugar frequency, Sweet score


How to cite this article:
Hegde P P, Ashok Kumar B R, Ankola A. Sugar consumption pattern of 13-year-old school children in Belgaum city, Karnataka. J Indian Soc Pedod Prev Dent 2005;23:165-7

How to cite this URL:
Hegde P P, Ashok Kumar B R, Ankola A. Sugar consumption pattern of 13-year-old school children in Belgaum city, Karnataka. J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2019 Nov 22];23:165-7. Available from: http://www.jisppd.com/text.asp?2005/23/4/165/19002


The recognition that sugars have an etiological role in dental caries has been with us for centuries.[1] Sucrose is the favored substrate for the cariogenic bacteria and the acid byproduct of its fermentation results in the demineralization of the tooth surface. Sugared items are the most relished substances by the children. Sweet preparation at home during the festive seasons or otherwise is a common trend in the Indian culture. The markets too are flooded with different kinds of sweets and to add to it, the globalization of India is adding varieties of sugared products into the country. Easy availability of sugar containing food and high consumption of these sweets if continued unabated, the dental caries among children would become a major public health problem. In this instance, Dietary counseling can be just appropriate to inhibit the carious process.[2] The present study was planned, to determine the sugar consumption pattern of the school children in Belgaum city and to organize for a diet counseling program.


   Materials and Methods Top


Assessing the pattern of sugar consumption and conducting diet counseling program was one of the activities of the 'School Dental program,' which was launched by KLES Institute of Dental Sciences Belgaum. Four schools were enrolled under this program (M.V. Herwadkar English High School, Sant Meera English Medium School, Vanita Vidyalaya English Medium School, and St. Mary's High School). All the children ( n = 379), pupils of eighth grade, 13-year old participated in the study. The children belonged to social class A, determined according to the occupation of the father.[3] Permission to carry out the study was obtained from the Assistant Educational Officer, Principal of the schools and the parents. None of the children refused to participate in the study. The children, parents, and the class teacher were blinded of the dental aim of the study and that it was conducted by dental staff, so as to avoid any change in their dietary pattern during the study period.

The pattern of sugar consumption was assessed using a 4-day diet diary in which each child had to record all items eaten or drunk on four consecutive days. Friday a.m. to Monday p.m. was the period used in order to include weekdays as well as weekends. Care was taken, not to record Diet diary on the festivals or birthday. Diet diary recording was demonstrated to the children in their classroom with an example on the blackboard [Figure - 1]. They had to record in detail everything they ate or drank in the order in which it was eaten. The amount of food item eaten was to be recorded in terms of household measurements such as one cup, one vati, or one teaspoon. The diet diary recording instructions given to the children were according to Nizel and Papas.[2] The class teacher was asked to remind and reinforce the children to fill the diet diary. The children were informed and assured that it was not a test and that the teacher would not see the completed forms. The dentist visited the schools on a number of occasions to clarify any uncertainties about the diaries and to encourage their completion. At the end of the 4-day the diaries were collected and were discussed individually in case of any ambiguities.

Analysis of data

The diet diary was analyzed for sucrose consumption according to the method described by Nizel and Papas.[2] The variables analyzed were:

•The sweet score

•At meal sugar exposure (AMSE)

•Between meal sugar exposure (BMSE)

•Total sugar exposure (TSE)

The mean, SD and/or frequency were calculated for all variables. Student's t -test was used to statistically analyze the gender difference with respect to the variables.


   Results Top


The sample consisted of 379 children but only 342 diet diaries were analyzed. Thirty-seven (10.9%) children whose diet diaries were incomplete were excluded. The sweet score for the sample ranged from 9.32 to 76.12/day. The AMSE ranged from 0 to 2/day. Majority, 76.31% ( n = 261) consumed sweets once at meal, 18.71% ( n = 64) had twice, while a very small percentage of children 4.97% ( n = 17) reported no intake of sweets at meals. The BMSE ranged from 2 to 6/day. Majority, 85.96% ( n = 294) had sugar exposure between meals on 3 and 4 occasions/day. None of the children in the present study displayed a total absence of exposure to sugar. The TSE ranged from 3 to 7/day. Majority of the children 84.5% ( n = 289) reported TSE on 4-5 occasions/day.

The gender comparison with respect to the mean values of sweet score, AMSE, BMSE, and TSE is showed in [Table - 1]. Albeit, the values for the males were slightly higher, no statistical significant difference was observed.


   Discussion Top


As per the sweet score classification,[2] it was observed that the recorded mean sweet score of the study sample, i.e. 31 ± 12.78/day was in the 'Watch Out' zone, implying that the sugar consumption was very high among the study group. 0.88 ± 0.33/day was the recorded mean AMSE, which was lower compared to the mean AMSE of 1.52 ± 0.73 and 1.65 ± 0.88 among 11- and 15-year-old children of Orissa, respectively, as reported by Sahoo et al.[4] In the present study, the mean BMSE recorded was 3.95 ± 0.87/day. Comparatively, a lesser mean BMSE has been reported by Sahoo et al.[4] of 1.62 ± 0.89 and 1.28 ± 0.91 among 11- and 15-year-old children, respectively. In the present study, the mean TSE of 4.83 ± 0.96/day, is similar to that reported by Burt et al.[5] of 4.3/day for the Midwestern teenagers and 4.2-4.9/day as reported by Olojugba and Lennon [6] in 12-year-old school children in Ondo, Nigeria. But, it is slightly higher than the mean TSE of 3.13 ± 1.08 and 2.91 ± 1.42/day reported by Sahoo et al[4] for 11- and 15-year-old children, respectively, while lower as compared to the TSE of 5.7/day among 11-12-year-old children of North Ireland[7] and 6-8/day among the English adolescents.[8] Differences are evident when sugar consumption pattern are compared with other study reports.[4],[7],[8] This can be attributed to the variation in socio-cultural, geographical factors, method employed to assess sugar intake, and study design. Diet in general and sugar intake in particular varies from individual to individual and is based on the socio-cultural and geographical location of the individual.

Different methods like diet diary, Interview method, weighing method, Questionnaire method, 24-hour recall can be used to assess the sugar intake of an individual, but there is no consensus on the most valid method of measuring dietary intake.[1] Comparing in between studies, using these different methods can thus lead to varying results.

In the present study, a 7-day diet diary recording was initially opted for. But, the results of the pilot study revealed that towards the end of the week (5th, 6th, and 7th day) the children were disinterested in diet recording and had missed on many recordings. Hence to reduce bias due to underestimation of the sugar intake a 4-day diet diary was decided.

Auxiliary findings observed while analyzing the diet diary were: a healthy practice of drinking milk (in the form of Bournvita, Complain, and other health drinks) at least twice daily was noticed in majority of the children. The increased frequency of sugar containing items in the present study was principally accounted for by the fizzy drinks and candies consumed in between meals. Majority of the times the sweets consumed were purchased from the market. A personal communication with the children revealed that any new chocolate or drink advertised on the Television, they were very eager to purchase and taste it. This calls for a comment 'Advertisements on Television influence these children to a great degree.' From public health point of view, Television advertisements, if used to positively motivate and influence the children to adopt healthy practices, can serve as a best health education aid.

The present study was carried for 13-year-old children, where the permanent teeth are fully erupted and this is the time of considerable caries activity and risk. In this instance dietary counseling to inhibit the carious process is just appropriate. Thus, this data was used to plan and organize a diet-counseling program for the children. During the diet-counseling program, the children were returned the analyzed diet diary wherein the sugared food item in the diary was circled in red. This circling in red helped the children to point out and separate the cariogenic and noncariogenic items. The children were surprised at the number of circled foods. Half an hour counseling session was conducted, as per the 'Step-By-Step Dietary counseling procedure for caries prevention' by Nizel and Papas.[2]

The most common strategy followed otherwise, despite limited success is simply to exhort the children to eat less sugar. The method we followed was a 'Tell Show And Do,' which perhaps can be speculated to have a greater impact. The objective of counseling session was to create awareness about the role of sugar in the etiology of caries and the importance of consuming restricted amount of sugar and thus to help the children to adopt a health conscious life style.


   Acknowledgment Top


The authors wish to thank Mrs.Triveni Kaul, Chief Dietician, at KLES, Institute of Dental Sciences, Belgaum for helping in the analysis of the Diet Diaries.

 
   References Top

1.Burt BA, Pai S. Sugar consumption and caries risk: A systematic review. J Dent Education 2001;65:1017-22.  Back to cited text no. 1    
2.Nizel AE, Papas AS. Dietary counseling for the prevention and control of dental caries. Nutrition in clinical dentistry. 3rd Ed WB Saunders: Philadelphia; 1989. p. 277-308.  Back to cited text no. 2    
3.Kulkarni SS, Deshpande SD. Caries prevalence and treatment needs in 11-15 year old children of Belgaum city. J Indian Soc Pedo Prev Dent 2002;20:12-5.  Back to cited text no. 3    
4.Sahoo PK, Tewari A, Chawla HS, Sachdev V. Interrelationship between sugar and dental caries-a study in child population of Orissa. J Indian Soc Pedo Prev Dent 1992;10:37-44.  Back to cited text no. 4    
5.Burt BA, Eklund SA, Morgan KJ, Larkin FE, Guire KE, Brown LO, et al . Effects of sugar intake and frequency of ingestion on dental caries increment in a three year longituidinal study. J Dent Res 1988;67:1422-9.  Back to cited text no. 5    
6.Olojugba OO, Lennon MA. Sugar consumption in 5 and 12-year old school children in Ondo state, Nigeria in 1985. Commun Dent Hlth 1990;7:259-65.  Back to cited text no. 6    
7.Kinirons MJ, Beattie G, Steele PA. The pattern of sugar consumption in social class groups of young adolescents in Northern Ireland. Commun Dent Hlth 1992;9:329-33.  Back to cited text no. 7    
8.Rugg-Gunn AJ, Hackett AF, Appleton DR, Jenkins GN, Eastoe JE. Relationship between dietary habits and caries increment assessed over two years in 405 English adolescent school children. Archs Oral Biol 1984;29:983-92.  Back to cited text no. 8    


Figures

[Figure - 1]

Tables

[Table - 1]


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