Documentos del Contrato

It is believed that a child’s nutritional status has a significant impact on their present and future health. The effects of a poor diet in young age groups are perhaps most easily observed in terms of dental health, but also are associated with the increasing public health problem of childhood obesity. Recent evidence suggests that many toddlers in the United Kingdom do not consume a diet that provides an adequate nutritional balance (Shepherd, 2008) and the levels of obesity and related health problems in this group are increasing. Dietary nourishment during infancy affects a baby’s response when exposed to infection during early childhood, and might influence disease he or she will develop in later life (Barker, 1998). Also, the pattern of infant feeding may be relevant to the development of childhood obesity, which in turn is related to adult obesity (de Bruin et al, 1996). The need for improving the Scottish diet is clear, as Scotland, like other industrialised nations, faces an epidemic of obesity and many linked secondary conditions (Scottish Executive, 2003). An approach aimed at improving the nutritional status of preschool children may not only reduce NMES

consumption and hence improve oral health, but may also improve the overall quality of pre-school children’s diet and thereby promote their growth and development (Sheiham & Watt, 2000).

2.5.1 Evidence of association of dental caries and childhood

obesity

Low socio-economic status increases the risk of both caries and obesity, and may be responsible for the existence of both in this vulnerable group of the population. Public health measures designed to modify dietary behaviour could have positive action on both of these childhood health burdens, and hence the long-term adult health

consequences displayed by both (Marshall, Eichenberger-Gilmore, Broffitt et al, 2007; Touger-Decker & Mobley, 2007).

Dietary behaviour is often perceived as a common underlying causative factor in both these disease processes. However a systematic review by Kantovitz et al (2006) found only three studies had high levels of evidence regarding this relationship, with only one showing a direct association between dental caries and obesity. Since then, large scale studies have shown statistically significant associations between body mass index (BMI) and the prevalence of dental caries in both the deciduous and permanent dentition (Willershausen et al, 2007; Sharma & Hedge, 2009; Vazquez-Nava et al, 2010), and conversely, no significant association between obesity and caries experience (Hong et al, 2008; Tramini et al, 2009). This disparity between studies could be partly due to the

difficulty in assessing dmft and DMFT in children who are at an age of moving from the deciduous to the permanent dentition, and the wide variable age range over which this occurs. Sanchez-Perez et al (2010) found that at aged 11 years, children with higher BMI had more erupted teeth (p< 0.001), as well as lower caries experience than children with lower BMI.

2.5.2 Prevalence of childhood obesity

The prevalence of obesity in childhood (classified as two to 15 year olds) is increasing rapidly, with values in England in 2007 of 17% among boys and 16% among girls (Reilly et al, 2009), and combined rates for overweight and obesity of 31% for boys and 29% for girls in 2010 (NHS Information Centre, 2010). NHS Scotland conducts a large-scale Child Health Surveillance Programme (CHSP), which collects BMI statistics for approximately 71% of children in Primary 1 class (five years of age) (ISD Scotland, 2010). In 2009/2010, among the ten participating health boards in Scotland, it was found that 20.4% of Primary 1 children were classified as overweight, with 8.2% termed obese and 4.1% severely obese. 3.1% were classified underweight (ISD Scotland, 2010).

2.5.3 Childhood obesity linked to adult obesity

Reilly et al (2003) reported that childhood obesity predicted adult obesity in 40-70% of children, potentially with associated risks to adult health. Systematic reviews of the literature have shown there is a positive association between rapid weight gain during infancy and the prevalence of obesity in later life (Baird et al, 2005; Monteiro & Victora, 2005).

2.5.4 Long term consequences of childhood obesity

Poor diet contributes to a range of serious long-term illnesses, which include coronary heart disease, certain cancers, strokes, type II diabetes and musculoskeletal problems such as osteoporosis (Ebbeling et al, 2002). High blood pressure and cholesterol levels, leading to hypertension and atherosclerosis, have been shown to develop from very early in life (Cowin et al, 2000). Obesity in childhood is not only linked to the development of immediate conditions, such as asthma and type II diabetes, but also increased middle-age mortality and morbidity, irrespective of adult weight status (Stamatakis et al, 2005).

2.5.5 Social inequalities affecting obesity

Socio-economic factors can lead to inequalities in health outcomes, as well as access to healthcare services (Shaw et al, 2009). Poor nutritional status is a specific cause of higher rates of ill health in low income households (Holmes et al, 2007). Higher numbers of overweight and obese individuals are found in areas of deprivation, low-income households and lower socio-economic groups (Pearce et al, 2008), and the greatest increase in obesity levels has been seen among children from lower income families. Data from both the CHSP and the 2003 Scottish Health Survey found that deprivation is strongly associated with obesity in children at pre- and school age, with a steady

increase in the prevalence of obesity from lowest in the SIMD least deprived quintile (5) to highest in the most deprived quintile (1) for all year groups (Grant et al, Scottish Public Health Observatory, 2007). Social and parental indicators of deprivation are closely related to the development of obesity in childhood (Stamatakis et al, 2005). Public health interventions need to address the increasing obesity rates in early

childhood, particularly targeting children from lower socio-economic backgrounds, who are most at risk of exposure to unhealthy behaviours (Campbell et al, 2008, Drieskens et al, 2009).