Mediation effect of body mass index on the association between serum magnesium level and insulin resistance in children from Mexico City.

BACKGROUND/OBJECTIVES: Reduced serum magnesium (Mg) levels have been associated with obesity, insulin resistance (IR), type 2 diabetes, and metabolic syndrome in adults. However, in the children population, the evidence is still limited. In this cross-sectional study, we aimed to analyze the association of serum Mg levels with the frequency of overweight and obesity and cardiometabolic traits in 189 schoolchildren (91 girls and 98 boys) between 6 and 12 years old from Mexico City. SUBJECTS/METHODS: Anthropometrical data were collected and biochemical parameters were measured by enzymatic colorimetric assay. Serum Mg level was analyzed by inductively coupled plasma mass spectrometry (ICP-MS). The triglyceride-glucose (TyG) index was used as a surrogate marker to evaluate IR. RESULTS: Serum Mg level was negatively associated with overweight (Odds ratio [OR] = 0.377, 95% confidence interval [CI] 0.231-0.614, p < 0.001) and obesity (OR = 0.345, 95% CI 0.202-0.589, p < 0.001). Serum Mg level resulted negatively associated with body mass index (BMI, ß = -1.16 ± 0.26, p < 0.001), BMI z-score (ß = -0.48 ± 0.10, p < 0.001) and TyG index (ß = -0.04 ± 0.04, p = 0.041). Through a mediation analysis was estimated that BMI z-score accounts for 60.5% of the negative association of serum Mg level with IR (Sobel test: z = 2.761; p = 0.005). CONCLUSION: Our results evidence that BMI z-score mediate part of the negative association of serum Mg level and IR in Mexican schoolchildren.

The Effects of an Educational Intervention About Front-of-Package Labeling on Food and Beverage Selection Among Children and Their Caregivers: Protocol for a Randomized Controlled Trial.

BACKGROUND: Overweight and obesity pose a global public health challenge and have a multifactorial origin. One of these factors includes obesogenic environments, which promote ultraprocessed foods characterized by being high in calories, saturated fats, added sugars, and sodium. In Mexico, it has been estimated that 30% of the total energy consumed comes from processed foods. The Modification to the Official Mexican Standards introduces nutritional information through black octagonal seals that alert consumers about products with excessive amounts of some components for a better food selection in the population. However, the effects of warning labels on processed food selection and purchases among children remain unknown. OBJECTIVE: We aimed to evaluate the impact of a digital educational intervention focusing on front-of-package warning labels on the food selection and purchasing behavior of elementary schoolchildren and their caregivers. METHODS: Children from 4 elementary schools in Mexico City, 2 public and 2 private schools, will participate in a randomized controlled trial. The schools will be chosen by simple random sampling. Schools will be randomized into 2 groups: intervention and control. In the control group, the dyads (caregiver-schoolchildren) will receive general nutritional education, and in the intervention group, they will receive guidance on reading labels and raising awareness about the impact of consuming ultraprocessed products on health. The educational intervention will be conducted via a website. Baseline measurements will be taken for both groups at 3 and 6 months. All participants will have access to an online store through the website, allowing them to engage in exercises for selecting and purchasing food and beverages. In addition, other measures will include a brief 5-question exam to evaluate theoretical understanding, a 24-hour reminder, a survey on food habits and consumption, application of a food preference scale, anthropometric measurements, and recording of school lunch choices. RESULTS: Registration and funding were authorized in 2022, and we will begin data collection in September 2024. Recruitment has not yet taken place, but the status of data analysis and expected results will be published in April 2025. CONCLUSIONS: The study is expected to contribute to evaluating whether reinforcing front-of-package warning labels with education enhances its effects and makes them more sustainable. Conducting this study will allow us to propose whether or not it is necessary to develop new intervention strategies related to front-of-package labeling for a better understanding of the population, improved food choices, and better health outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT06102473; https://clinicaltrials.gov/study/NCT06102473. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54783.

Development and Validation of a Method of Body Volume and Fat Mass Estimation Using Three-Dimensional Image Processing with a Mexican Sample.

Body composition assessment using instruments such as dual X-ray densitometry (DXA) can be complex and their use is often limited to research. This cross-sectional study aimed to develop and validate a densitometric method for fat mass (FM) estimation using 3D cameras. Using two such cameras, stereographic images, and a mesh reconstruction algorithm, 3D models were obtained. The FM estimations were compared using DXA as a reference. In total, 28 adults, with a mean BMI of 24.5 (±3.7) kg/m2 and mean FM (by DXA) of 19.6 (±5.8) kg, were enrolled. The intraclass correlation coefficient (ICC) for body volume (BV) was 0.98-0.99 (95% CI, 0.97-0.99) for intra-observer and 0.98 (95% CI, 0.96-0.99) for inter-observer reliability. The coefficient of variation for kinetic BV was 0.20 and the mean difference (bias) for BV (liter) between Bod Pod and Kinect was 0.16 (95% CI, -1.2 to 1.6), while the limits of agreement (LoA) were 7.1 to -7.5 L. The mean bias for FM (kg) between DXA and Kinect was -0.29 (95% CI, -2.7 to 2.1), and the LoA was 12.1 to -12.7 kg. The adjusted R2 obtained using an FM regression model was 0.86. The measurements of this 3D camera-based system aligned with the reference measurements, showing the system's feasibility as a simpler, more economical screening tool than current systems.

Evaluation of height prediction models: from traditional methods to artificial intelligence.

BACKGROUND: Traditional methods for predicting adult height (AHP) rely on manual readings of bone age (BA). However, the incorporation of artificial intelligence has recently improved the accuracy of BA readings and their incorporation into AHP models. METHODS: This study aimed to identify the AHP model that fits the current average height for adults in Mexico. Using a cross-sectional design, the study included 1173 participants (5-18 yr). BA readings were done by two experts (manually) and with an automated method (BoneXpert®). AHP was carried out using both traditional and automated methods. The best AHP model was the one that was closest to the population mean. RESULTS: All models overestimated the population mean (males: 0.7-6.7 cm, females: 0.9-3.7 cm). The AHP models with the smallest difference were BoneXpert for males and Bayley & Pinneau for females. However, the manual readings of BA showed significant interobserver variability (up to 43% of predictions between observers exceeded 5 cm using the Bayley & Pinneau method). CONCLUSION: Traditional AHP models relying on manual BA readings have high interobserver variability. Therefore, BoneXpert is the most reliable option, reducing such variability and providing AHP models that remain close to the mean population height. IMPACT: Traditional models for predicting adult height often result in overestimated height predictions. The manual reading of bone age is prone to interobserver variability, which can introduce significant biases in the prediction of adult height. The BoneXpert method minimizes the variability associated with traditional methods and demonstrates consistent results in relation to the average height of the population. This study is the first to assess adult height prediction models specifically in the current generations of Mexican children.

Association between maternal diet, smoking, and the placenta MTHFR 677C/T genotype and global placental DNA methylation.

INTRODUCTION: The placenta provides nutrients to the fetus, and it has protective effects against harmful substances. Unhealthy maternal diets and toxic agents might increase free radical (FR) production. Elevated FR levels are associated with a high risk of oxidative stress, which may cause DNA damage. DNA might be oxidized in the placenta, occasionally affecting its methylation profile due to 8-hidroxy-2'-deoxyguanosine formation. METHODS: This study assessed 130 mothers and their children. The maternal's nutritional patterns were determined using the Food Frequency Questionnaire. Information on smoking and alcohol consumption was collected during the medical examination. Data on placental DNA were obtained to determine the MTHFR 677C/T genotype and the proportion of placental DNA methylation (pDNAm). RESULTS: Consumption of vitamins and folic acid was above 85%. The pDNAm was found to be correlated with gestational age and coffee intake. Mothers with a smoking history had a low pDNAm. Placentas with the TT genotype had a higher but not significant pDNAm. In the placentas with the CC/CT genotype, the pDNAm was positively associated with carbohydrate and biotin intake. However, the TT genotype was negatively associated with folate and vegetable intake. DISCUSSION: The pDNAm was positively associated with coffee intake, but not with macro-, and micronutrient intake. However, it was negatively associated with cigarette smoking. The placentas with the CC/CT genotype had a lower pDNAm than those with the TT genotype. In the placentas with the CC/CT or TT genotype, methylation was positively, and negatively associated with micro- or macronutrients, respectively.

Differences in the absolute muscle strength and power of children and adolescents with overweight or obesity: a systematic review.

This study aimed to describe absolute muscle strength and power in children and adolescents with obesity, overweight and normal weight, and the assessment tests and tools used. We retrieved observational studies from MEDLINE (PubMed), TripDataBase, Epistemonikos, EBSCO essentials, NICE, SCOPUS, and LILACs up to February 2023. In addition, we recovered data from studies with at least three comparison groups (obesity, overweight, normal weight) and with a description of the absolute muscle strength and power and the assessment tests and instruments used. The methodologic quality of the studies was assessed with the Joanna Briggs checklist, and the review was carried out using the PRISMA 2020 methodology. Eleven studies with 13,451 participants from 6 to 18 years of age were once included, finding that the absolute muscle strength of their upper extremities was greater when they were overweight or obese; however, in the same groups, absolute muscle strength was lower when they carried their body weight. In addition, lower limb absolute muscle strength was significantly lower in obese participants than in normal weight, regardless of age and gender. The most used tools to measure the absolute muscle strength of the upper limbs were the grip dynamometers and push-up exercises. In contrast, different jump tests were used to measure the power of the lower limbs. There are great differences in muscle strength and power between overweight or obese children and adolescents and those with normal weight. Therefore, it is recommended to use validated tests, preferably that assess strength through the load of the patient's body weight, either of the upper or lower limbs, for greater evaluation objectivity that facilitates the management of these children and adolescents.

Behavior of immunoglobulin G antibodies for SARS-COV-2 in Mexican pediatric patients with comorbidities: a prospective comparative cohort study.

Background: More than two years after the pandemic of COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) there is a great lack of information. The presence of immunoglobulin G (IgG) have been related with disease severity. Patients with comorbidities could develop more severe infection; however, the evaluation of the humoral response in pediatric population are needed especially in patients with comorbidities. Our aim was to describe the behavior of IgG in pediatric patients and to know if there is a difference between patients with comorbidities. Methods: A prospective comparative cohort study was carried out in a single center from June 2020 to January 2021, with a follow-up of 6 months. The study included all the subjects with confirmatory test for SARS-CoV-2 from 1 month to 17 years 11 months, the follow-up of the disease's evolution and measurement of IgG antibodies was collected. We obtained the clinical data, and comorbidities like arterial hypertension, diabetes, obesity, and cancer, the initial symptoms were recorded as well as the evolution regarding the severity of COVID-19 and the need for hospitalization, intensive care unit or mechanical ventilation. The follow up was carried out through medical consultation with an appointment every month that included direct interrogation, examination, and peripheral blood collection for the IgG quantification. The antibodies detection was done through peripheral blood and chemiluminescence microparticle immunoassay. Results: A total of 237 patients with positive polymerase chain reaction (PCR) for SARS-COV-2 were included, of which 147 presented IgG antibodies (62%), 112 (76%) without comorbidity and 35 (24%) with comorbidities, by the sixth month only 2.7% continue with positive antibody measurements. Patients with comorbidities reach higher IgG levels than patients without comorbidities the basal titters were: 5.17 for patients without comorbidities vs. 6.96 for the group with comorbidities (P<0.001). Conclusions: We found an association between the presence of comorbidities and high levels of IgG units in pediatric patients with COVID-19. Additionally, patients with more severe course of the disease have higher levels of IgG and by the third month less than 35% have immunity.

A large-scale analysis of refractive errors in students attending public primary schools in Mexico.

A cross-sectional, retrospective study was conducted from September 2013 through July 2014 to determine the prevalence of refractive errors among students attending public primary schools in Mexico. Among 3,861,156 students at 14,566 public primary schools in all 32 states of Mexico, teachers identified reduced visual acuity in 1,253,589 (32.5%) using visual acuity measurement. Optometrists confirmed 391,498 [31.2%, mean (SD) age: 8.8 (1.9) years; 204,110 girls (52.9%)] had refractive errors using visual acuity measurement and noncycloplegic static retinoscopy. Among 288,537 (72.4%) of children with previous eyeglasses usage data reported, 241,505 (83.7%) had uncorrected refractive errors. Before prescription eyeglasses were provided, 281,891 students (72%) had logMAR visual acuity ≤ 0.2; eyeglasses corrected vision loss in 85.6% (n = 241,352) of them. Simple myopic astigmatism was the most frequent refractive error (25.7%, n = 100,545). Astigmatism > - 1.00 diopters was present in 54.6% of all students with ametropia. The anisometropia rate based on spherical equivalent difference between right and left eye ≥ 1.50 diopters was 3.9% (n = 15,402). Uncorrected refractive errors are an important issue in primary school students in Mexico. An updated study is needed to analyze the evolving trends over the past decade.

Cross-sectional evaluation of the association between greenness and cognitive performance in Mexican pre-pubertal boys.

BACKGROUND: Evidence shows that greenspace exposure benefits children's health and cognitive development. However, evidence assessing this association in young children in low- and middle-income economies is scarce. OBJECTIVE: To assess the association between exposure to greenness and cognitive performance in pre-pubertal boys living in Mexico City. METHODS: Cross-sectional study using data from 144 boys aged 6-11 years living in Mexico City in 2017 and enrolled in the "MetCog" study. Cognitive performance was evaluated through selected Wechsler Scale for Intelligence in Children Fourth Edition (WISC-IV) and Neuropsychological Assessment of Children (Evaluación Neuropsicológica Infantil, ENI) tests. Exposure to greenness was assessed through Normalised Difference Vegetation Index (NDVI) at 300, 500, 1500, 2000, and 3000 m buffer zones from children's residences. Multiple linear regression analysis was undertaken to assess associations between cognitive performance and greenness (aß) with 95% confidence intervals (CI) and adjusted for potential confounding variables. Significance was set at q < 0.05 after False Discovery Rate (FDR) correction. RESULTS: A positive association was found between the NDVI Interquartile Range (IQR) at 2000 m and the WISC-IV block design test score (aß 2000 = 1.18, 95% CI = 0.31, 2.06; q < 0.05), which assesses perceptual reasoning. Positive associations were found with NDVI IQR at 1500 m and WISC-IV block design (aß1500 = 1.00, 95% CI = 0.14, 1.86) and matrix reasoning (aß1500 = 0.83, 95% CI = 0.06, 1.61) scores, but neither survived FDR correction. No significant associations were found between NDVI IQR at any buffer size with other WISC-IV and ENI task scores. CONCLUSIONS: Greater exposure to greenness was associated with higher perceptual reasoning skills in 144 pre-pubertal boys living in Mexico City. Thus, urban planning should consider increasing vegetation in megacities, especially in neighbourhoods with high percentages of young children.

Prevalence of type 2 diabetes mellitus in the pediatric population of a third-level care hospital in Mexico City in 2013 and 2018.

BACKGROUND: Diabetes mellitus type 2 (T2DM) is a state of hyperglycemia due to a defect in the secretion and/or action of insulin, and it represents the most common form of diabetes worldwide. In Mexico, 10.3% of the adult population have been diagnosed with T2DM and it is expanding to the pediatric population. AIM: To evaluate and compare the prevalence of T2DM in the pediatric population at the Children's Hospital, "Hospital Infantil de México Federico Gómez (HIMFG)", at two time periods: 2013 vs 2018. METHODS: A comparison of two cross-sectional studies was done (2013 and 2018). The study population was comprised of children and adolescents 8-17 years old, from the Diabetes Clinic at the aforementioned institution. A comprehensive interrogation regarding family history and perinatal antecedents was performed. Complete blood work after 12 h of fasting was obtained to determine serum levels of glucose, glycated hemoglobin, lipid profile, C-peptide, and insulin. The data were analysed using the statistical software package SPSS v. 23.0. A P value of < 0.05 was considered statistically significant. RESULTS: A total of 151 patients were included: 47 from 2013, and 104 from 2018. There were age differences noted between the two periods with younger patients presenting T2DM in 2013. Also, T2DM predominated in the male sex in 55.36% in 2013 vs 32.7% in 2018. An increased prevalence of T2DM was noted from 2013 to 2018 (20.2% vs 33.0%, respectively), which was a statistically significant 12.8% increase (P < 0.0001). The illness phenotype was more aggressive in the 2018 group with the presence of a higher proportion of obesity, insulin resistance, and adverse lipid profiles. CONCLUSION: The prevalence of T2DM at the HIMFG institution from 2013 to 2018 increased by 12.8% (20.2% vs 33.0%, respectively). The study results demonstrate the need for vigilance in T2DM trends, and to strengthen programs of healthy nutrition and physical activity as well as early detection and risk factors for obesity, data on insulin resistance, and metabolic syndrome, with the aim of preventing the development of T2DM.

A Multi-Component Educational Intervention for Addressing Levels of Physical Activity and Sedentary Behaviors of Schoolchildren.

Physical inactivity and a sedentary lifestyle are risk factors for excess weight and obesity in childhood. It is, therefore, necessary to adopt strategies which can modify these behaviors during childhood, the age at which habits are formed. This study aimed to evaluate the impact of an educational intervention using digital media and face-to-face activities involving children, parents, and the school community on the level of physical activity and sedentary behavior among schoolchildren. This was a secondary analysis of data obtained from a community trial in which students from four primary schools in Mexico City participated. Two schools were assigned to the intervention group (IG) and two to the control group (CG). The intervention lasted 12 months and included a face-to-face component, which involved sessions and workshops for parents and children, as well as visual material for children and a distance component utilizing electronic means (web portal and text messages to mobile phones) for parents. Anthropometric measurements were taken and information was collected on moderate to vigorous physical activity performed by the children and on the time that the schoolchildren spent in front of screens at the beginning of the study and at 6 and 12 months. Information on 201 children from the IG and 167 children from the CG was included in the analysis. At 12 months, the IG showed a mean decrease of 33.4 min/d [95% CI: -53.5 to -13.3] in screen time, while the CG showed an increase of 12.5 min/d [CI 95%: -10.5 to 35.6], p = 0.003. After 12 months of follow-up, applying this educational intervention reduced the time that schoolchildren spent in front of screens. Educational intervention is a feasible and accessible strategy for promoting changes in sedentary behaviors in the school-age population.

Long COVID in children and adolescents: COVID-19 follow-up results in third-level pediatric hospital.

Introduction: In children, the manifestations of coronavirus disease 2019 (COVID-19) in the acute phase are considered mild compared with those in adults; however, some children experience a severe disease that requires hospitalization. This study was designed to present the operation and follow-up results of the Post-COVID-19 Detection and Monitoring Sequels Clinic of Hospital Infantil de Mexico Federico Gómez in managing children with a history of SARS-CoV-2 infection. Methods: This was a prospective study conducted from July 2020 to December 2021, which included 215 children aged 0-18 years who tested positive for SARS-CoV-2 on polymerase chain reaction and/or immunoglobulin G test. The follow-up was conducted in the pulmonology medical consultation; ambulatory and hospitalized patients were assessed at 2, 4, 6, and 12 months. Results: The median age of the patients was 9.02 years, and neurological, endocrinological, pulmonary, oncological, and cardiological comorbidities were the most commonly observed among the patients. Moreover, 32.6% of the children had persistent symptoms at 2 months, 9.3% at 4 months, and 2.3% at 6 months, including dyspnea, dry cough, fatigue, and runny nose; the main acute complications were severe pneumonia, coagulopathy, nosocomial infections, acute renal injury, cardiac dysfunction, and pulmonary fibrosis. The more representative sequelae were alopecia, radiculopathy, perniosis, psoriasis, anxiety, and depression. Conclusions: This study showed that children experience persistent symptoms, such as dyspnea, dry cough, fatigue, and runny nose, although to a lesser extent than adults, with significant clinical improvement 6 months after the acute infection. These results indicate the importance of monitoring children with COVID-19 through face-to-face consultations or telemedicine, with the objective of offering multidisciplinary and individualized care to preserve the health and quality of life of these children.

Leukocyte surface expression of the endoplasmic reticulum chaperone GRP78 is increased in severe COVID-19.

Hyperinflammation present in individuals with severe COVID-19 has been associated with an exacerbated cytokine production and hyperactivated immune cells. Endoplasmic reticulum stress leading to the unfolded protein response has been recently reported as an active player in inducing inflammatory responses. Once unfolded protein response is activated, GRP78, an endoplasmic reticulum-resident chaperone, is translocated to the cell surface (sGRP78), where it is considered a cell stress marker; however, its presence has not been evaluated in immune cells during disease. Here we assessed the presence of sGRP78 on different cell subsets in blood samples from severe or convalescent COVID-19 patients. The frequency of CD45+sGRP78+ cells was higher in patients with the disease compared to convalescent patients. The latter showed similar frequencies to healthy controls. In patients with COVID-19, the lymphoid compartment showed the highest presence of sGRP78+ cells versus the myeloid compartment. CCL2, TNF-α, C-reactive protein, and international normalized ratio measurements showed a positive correlation with the frequency of CD45+sGRP78+ cells. Finally, gene expression microarray data showed that activated T and B cells increased the expression of GRP78, and peripheral blood mononuclear cells from healthy donors acquired sGRP78 upon activation with ionomycin and PMA. Thus, our data highlight the association of sGRP78 on immune cells in patients with severe COVID-19.

Relationship of Serum Zinc Levels with Cardiometabolic Traits in Overweight and Obese Schoolchildren from Mexico City.

Zinc (Zn) participates as a cofactor for many enzymes in the cellular metabolism, and its serum levels have been associated with different metabolic diseases, especially obesity (OB). Nevertheless, its associations are not clear in the children population. The objective of this study is to evaluate the association between serum Zn levels (SZn) with overweight/obesity status (OW/OB), as well as its cardiometabolic traits in a population of children in Mexico City. Anthropometrical data (body mass index z score (BMIz)), demographic variables (age and sex), and cardiometabolic traits (total cholesterol (TC), high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), triglycerides (TG), fasting plasma glucose (FPG), and insulin) were analyzed in this cross-sectional study. SZn were measured by inductively coupled plasma mass spectrometry (ICP-MS). The population included 210 children from Mexico City (girls (n = 105) and boys (n = 105)) between ages 6 and 10 years. Normal-weight (NW) schoolchildren had higher SZn concentrations (66 µg/dL; IQR: 48 to 91) compared to OW or OB schoolchildren (61 µg/dL; IQR: 45 to 76). The data showed a significant negative association between SZn and BMIz without sex exclusion (r = - 0.181 and p = 0.009). The boy's population did not show an association between the SZn and BMIz compared to the girl's population which showed a significant negative association (r = - 0.277 and p = 0.004). In addition, other associations were found between SZn and TC (boys (r = 0.214 and p = 0.025), LDLc (boys (r = 0.213 and p = 0.029), and TG (girls (r = - 0.260 and p = 0.007)). Moreover, 38.6% of the total children in our population study had Zn deficiency (ZnD). NW schoolchildren had higher SZn concentrations compared to OW or OB schoolchildren. A diet low in Zn can be a factor to evaluate in the development of childhood OB in Mexico. However, further studies need to be performed on the children Mexican population to replicate and confirm our findings.

Overweight and Obesity Are Positively Associated with Serum Copper Levels in Mexican Schoolchildren.

Due to its relationship with oxidative stress and inflammation responses, obesity and its cardiometabolic implications have been related with serum copper (Cu). Hence, we analyzed the association of overweight (OW) and obesity (OB) status and cardiometabolic traits with serum Cu level in Mexican schoolchildren. Anthropometrical data and cardiometabolic traits were analyzed in this cross-sectional study. Serum Cu level was measured by inductively coupled plasma mass spectrometry. The study involved 191 schoolchildren (93 girls and 98 boys) with a mean age of 8.054 ± 1.170 years. Children with OW and OB had higher serum Cu levels than children with normal weight (NW) (mean difference: OW vs NW = 51.85 µg dL-1, OB vs NW = 47.22 µg dL-1, p < 0.001). In a multiple linear regression model, OW and OB status were positively associated with serum Cu levels (ßOW = 49.85, 95% confidence interval (95% CI) 35.84-63.87, p < 0.001; ßOB = 44.38, 95% CI 27.70-61.05, p < 0.001). We did not identify any significant association between cardiometabolic traits and serum Cu level. In conclusion, our results show an association of the presence of OW and OB with higher serum Cu levels, for the first time in Mexican schoolchildren. However, further functional studies are needed to better understand the role of Cu in the pathophysiology of obesity.

Effects of Carbonated Beverage Consumption on Oral pH and Bacterial Proliferation in Adolescents: A Randomized Crossover Clinical Trial.

Sugary soft drinks modify salivary pH and favor bacterial proliferation and are associated with the development of caries. Information on the effects of consuming carbonated drinks without sucrose is limited. Methods: In this crossover clinical trial, salivary and dental biofilm pH were determined at 0, 5, 10, 15, 30, 45, and 60 min after the participants (n = 18) ingested a soft drink with sucrose, a soft drink with aspartame/acesulfame K, carbonated water, and plain water on different days. Dental biofilm cultures were conducted at 0- and 120-min. Results: Salivary pH decreased significantly after ingestion of the sucrose-containing soft drink when compared with the other types of beverages (median difference, -0.3--0.4, p ≤ 0.05), and the greatest difference was found with mineral water. A greater bacterial proliferation (Colony Forming Units [CFU]) was observed after ingestion of the drink with sucrose (↑310 × 103 CFU, p ≤ 0.01), followed by the drink with aspartame/acesulfame K (↑160 × 103 CFU, p ≤ 0.01) and carbonated water (↑60 × 103 CFU, p ≤ 0.05). No significant changes in bacterial proliferation were observed after the consumption of natural water. Conclusions: Ingestion of sucrose-containing soft drinks favors the acidification of salivary pH and the bacterial proliferation of dental biofilm. Although to a lesser extent, soft drinks containing aspartame/acesulfame K also favor bacterial proliferation.