Table 3.

Negative association between caries and BMI (higher caries associated with lower BMI)

Authors	Country	Design	N	Age	Sampling	Dental rating	HDI*	Dental measure	Significant cariogenic risk factors	Sample demographics
Benzian et al. (2011)	Philippines	CS	1951	11-13	Stratified cluster sampling (68 public schools)	3* at dentinal/cavity level	112	DMFT+dmft index PUFA+pufa (odontogenic infections) index Also categorised: dmft+DMFT >0 PUFA/+pufa <1; >1	Higher DMFT+dmft rates in underweight than normal weight. Higher PUFA+pufa index in underweight than normal weight. Final regression model found PUFA+pufa >0, Gender (M), No. siblings (>4) more likely to have low BMI PUFA/pufa index better predictor or BMI than DMFT/dmft Children with caries involving pulp or with odontogenic infection had increased risk of low BMI	Caries Prevalence: 82.3%  Mn DMFT+dmft = 3.12 Odontogenic infections:  55.7%  Mn PUFA+pufa= 1.15 BMI:  Above normal: 1%  Below normal: 27.1%
Cameron et al. (2006)	Scotland	CS	165 children with severe dental decay	3-11	Restricted: Children attending for extraction under GA	2	28	dmft dentine caries	Higher dmft in underweight children Higher dental caries also associated with Carstairs index (measure of social deprivation)	Caries: Mn dmft 7.9 (SD=3.5) BMI: stats not provided  71% children socially deprived
Floyd (2009)	Taiwan	CS	577	6	Two schools (affluent and less affluent) in Taipei	3	24	def	Higher caries (def) associated with lower BMI in less affluent group but not in affluent group. Housing and parental occupation for the less affluent sample were marginally associated (p=0.061 and 0.071 respectively)	Mn def:  Less affluent group =  6.81(SD=3.66)  Affluent group = 4.78(SD= 3.12) BMI :  Less affluent group = 14.04  (SD=1.33)  Affluent Group = 14.80  (SD=1.83)
Kopycka-Kedzierawski et al. (2008) a	USA	CS	10180	2-18	NHANES III (1988–1994) Nationally representative sample	2	4	DMFS and dfs dichotomised as either having caries experience or not Dfs and DFS in children aged 2–11 years were estimated	Age 6–11 years: Higher caries risk in Normal-weight children than: •at-risk or overweight (decid) •overweight (Perm) Age 12–18 years: Higher caries risk in Normal-weight children than: •overweight (Perm) Multiple logistic regression: 6–11 years of age, poverty, low level of education of household head and serum cotinine levels significantly associated with increased risk of caries experience in the primary dentition. Low level of education of household head, blood lead level above the median and other race/ ethnicity associated with increased risk of having caries experience in permanent dentition 12–18 years of age: Low level of education of household head and time since last dental visit also associated with increased risk of caries experience in permanent dentition	Caries prevalence (%): 6-11yrs old (Primary dentition)  Overall:49.5 (1.6)  Overweight= 40.6 (4.7)  At risk = 45.5 (4.6)  Normal weight= 51.4 (1.6)  Underweight = not reported 6-11yrs old (Permanent dentition)  Overall:25.9 (1.7)  Overweight= 17.6 (2.9)  At risk = 29.9 (4)  Normal weight= 26.5 (1.7)  Underweight = not reported 12-18yrs (Permanent dentition)  Overall: 66.3 (1.9)  Overweight= 57.7 (4.6)  At risk =67.8 (4.7)  Normal weight= 67.2 (2.2)  Underweight = not reported
Narksawat et al. (2009)	Thailand	CS	862	12-14	Quasi stratified sampling of 77 districts	3*	103	Prevalence DMFT =/>0	Thai Ministry of Public Health manual used to classify children as underweight, normal, overweight and obese. Inverse association between nutritional status and DMFT	Caries prevalence: 62.1% Mn DMFT:  Overall sample = 1.93 (2.16)  Normal weight: 2.03 (2.2)  Underweight : 2.19 (2.19)  Overweight: 1.23 (1.86)  Obese: 0.89 (1.36) BMI:  Obese: 6.3%  Overweight: 5.3 %  Normal :78.3%  Underweight: 10.1%
Ngoenwiwatkul & Leela-Adisorn (2009)	Thailand	CS	212	6-7	Two primary schools	3 – cavity level	103	Dmfs index Prevalence dmfs =/>0	Higher DMFT index with decreased BMI Gender (Boys) for dental caries status (not dmfs) on primary dentition	Caries Prevalence: 80.2% Mn dmfs =12.4 (12.3)  70% of children experienced  toothache Mn BMI: 15.5 (4.6)  45.8% participants in low  percentile (5th<BMI-for- age<15th)
Olivira et al.(2008)	Brazil	CS	1018	1-5	Randomly selected from all children attending for vaccinations in 17 Health centres in city of Diadema	4	84	dmsf index Dichotomous dmfs =/>6	Mothers’ and fathers’ education level, household overcrowding, and number of children associated with dental caries prevalence. For ECC (LR): Caries prevalence and mothers’ education ,age of child, low BMI and clinically detectable dental plaque .The final hierarchical model demonstrated that mothers’ level of education, age, dental plaque were associated with and dental caries prevalence For S-ECC (LR): BMI not associated with severity Mothers’ education ,family income ,age lower weight-for-age and clinically detectable dental plaque related to dental caries severity	Caries Prevalence: 23.4%  S-ECC(dmfs≥6) = 8.2%
Sanchez-Perez et al. (2010)	Mexico	L	110 with 88 at 4-year follow up	7-11	Public elementary school in middle-income area of Mexico City	3 – cavity level	57	dmft/DMFT dmfs/DMFS	Higher dmfs scores associated with lower SE level	Caries Prevalence:  At age 7= 59.1%  At age 8= 55.7%  At age 9= 59.1%  At age 10 = 50%  At age 11= 40.9% BMI: Thin 25%  Normal 45.5%  At risk of overweight 12.5%  Overweight 17%
Sharma & Hedge (2009)	India	CS	500 sample of convenience	8-12	Department of Pedodontics ad Preventive Children Dentistry, A.B Shetty Memorial Institute of Dental Sciences, Mangalore	2 – whether initial caries was included is not specified	134	DMFS/dmfs	Higher rates of dental caries (DMFS) in overweight and obese children than normal weight children. Underweight children had significantly higher DMFS rates (but not dfs) than normal weight, overweight and obese children.	Mn DFMS:  Underweight: 3.11  Normal weight: 1.58  Overweight: 2.48  Obese: 2.85 Mn dfs:  Underweight: 2.00  Normal weight: 2.14  Overweight: 4.79  Obese: 3.25 BMI:  Underweight: 8.6%  Normal weight: 58.4%  Overweight/at risk:  22.2%  Obese: 10.8%