Benjamin W Chaffee1, Carlos Alberto Feldens2, Márcia Regina Vítolo3. 1. Department of Preventive and Restorative Dental Sciences, University of California San Francisco; Division of Epidemiology, University of California Berkeley. Electronic address: benjamin.chaffee@ucsf.edu. 2. Department of Pediatric Dentistry, Universidade Luterana do Brasil, Canoas, Brazil. 3. Department of Nutrition, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil.
Abstract
PURPOSE: To estimate the association between breastfeeding 24 months or beyond and severe early childhood caries (S-ECC). METHODS: Within a birth cohort (n = 715) from low-income families in Porto Alegre, Brazil, the age 38-month prevalence of S-ECC (≥4 affected tooth surfaces or ≥1 affected maxillary anterior teeth) was compared over breastfeeding duration categories using marginal structural models to account for time-dependent confounding by other feeding habits and child growth. Additional analyses assessed whether daily breastfeeding frequency modified the association of breastfeeding duration and S-ECC. Multiple imputation and censoring weights were used to address incomplete covariate information and missing outcomes, respectively. Confidence intervals (CIs) were estimated using bootstrap resampling. RESULTS: Breastfeeding 24 months or beyond was associated with the highest adjusted population-average S-ECC prevalence (0.45; 95% CI, 0.36 to 0.54) compared with breastfeeding less than 6 months (0.22; 95% CI, 0.15 to 0.28), 6-11 months (0.38; 95% CI, 0.25 to 0.53), or 12-23 months (0.39; 95% CI, 0.20 to 0.56). High-frequency breastfeeding enhanced the association between long-duration breastfeeding and caries (excess prevalence due to interaction: 0.13; 80% CI, -0.03 to 0.30). CONCLUSIONS: In this population, breastfeeding 24 months or beyond, particularly if frequent, was associated with S-ECC. Dental health should be one consideration, among many, in evaluating health outcomes associated with breastfeeding 24 months or beyond.
PURPOSE: To estimate the association between breastfeeding 24 months or beyond and severe early childhood caries (S-ECC). METHODS: Within a birth cohort (n = 715) from low-income families in Porto Alegre, Brazil, the age 38-month prevalence of S-ECC (≥4 affected tooth surfaces or ≥1 affected maxillary anterior teeth) was compared over breastfeeding duration categories using marginal structural models to account for time-dependent confounding by other feeding habits and child growth. Additional analyses assessed whether daily breastfeeding frequency modified the association of breastfeeding duration and S-ECC. Multiple imputation and censoring weights were used to address incomplete covariate information and missing outcomes, respectively. Confidence intervals (CIs) were estimated using bootstrap resampling. RESULTS: Breastfeeding 24 months or beyond was associated with the highest adjusted population-average S-ECC prevalence (0.45; 95% CI, 0.36 to 0.54) compared with breastfeeding less than 6 months (0.22; 95% CI, 0.15 to 0.28), 6-11 months (0.38; 95% CI, 0.25 to 0.53), or 12-23 months (0.39; 95% CI, 0.20 to 0.56). High-frequency breastfeeding enhanced the association between long-duration breastfeeding and caries (excess prevalence due to interaction: 0.13; 80% CI, -0.03 to 0.30). CONCLUSIONS: In this population, breastfeeding 24 months or beyond, particularly if frequent, was associated with S-ECC. Dental health should be one consideration, among many, in evaluating health outcomes associated with breastfeeding 24 months or beyond.
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