Food Insecurity and Dental Caries: Role of Calcium and Vitamin D as Biomarkers in Adolescents.

Objectives: Previous studies have shown that food insecurity is a risk factor for dental caries in children and adults in the US. In this study, we investigated the potential protective effects of Calcium and Vitamin D against dental caries, in adolescents aged 12-19, with or without evidence of food insecurity.
Methods: A cross-sectional study was carried out using the National Health and Nutrition Examination 2013-2014 dataset. The main outcome was evidence of dental caries, measured using the Decayed, Missing, Filled (DMF) index. Serum Vitamin D and calcium level were used as predictors. Population weight bivariate and multivariate logistic regression models were used to test each predictor in food secure and food insecure adolescents, independently. Vitamin D was defined as inadequate if <50 nmol/L or adequate ≥50 nmol/L. Calcium levels (mg/dL) were used as a continuous variable. Adjusted models were controlled for the following covariates; gender, race, poverty, barriers to dental care, last dental visit, food assistance program (WIC), and brushing frequency.
Results: A total of 1,028 adolescents were included in our analysis. Overall, in the unadjusted model, adolescents with adequate levels of vitamin D were 1.8 times more likely to have higher calcium level (OD=1.82 p=0.04[AA1] ). There was a trend for food secure adolescents to have higher vitamin D (p=0.06) and calcium level (p=0.07). In food insecure adolescents, approximately one third had inadequate vitamin D levels with a mean calcium level of 9.58mg/dL. On the other hand, 77.9% of adolescents in the food secure group had adequate level of vitamin D with a mean calcium level of 9.68 mg/dL. After controlling for confounding factors, every 0.1 mg/dL unit increase in calcium, resulted in a 4.3% reduction of dental caries (Odds Ratio (OD)=0.57 p=0.047). There was no significant relationship between Vitamin D and dental caries in either group.
Conclusions: Identification of nutritional biomarkers associated with dental caries, especially in those whom suffer from food insecurity, can help dentists in delivering tailored dietary recommendations. Specifically, an increase intake of calcium can be a powerful protectant against dental caries.