Association between early childhood caries and parental education and the link to the sustainable development goal 4: a scoping review.

BACKGROUND: The goal of the United Nations Sustainable Development Goal (SDG) 4 is to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. The aim of this scoping review was to map the current evidence on the association between the prevalence of early childhood caries (ECC) and parental education; and to identify possible pathways by which parental education may protect against ECC. METHODS: The two questions that guided this review were: what is the existing evidence on the association between maternal and paternal education and ECC; and what are the pathways by which parental education protects against ECC? The initial search was conducted in January 2023 in PubMed, Web of Science and Scopus. Articles published in English between January 2000 and October 2022 that reported on the association between parental education and ECC were screened, and the extracted data were compiled, summarized, and synthesized. Review papers and non-primary quantitative research papers were excluded from the full-text review. Open coding was applied to develop a conceptual framework. RESULTS: In total, 49 studies were included: 42 cross-sectional, 3 case-control and 4 cohort studies. The majority (91.8%) reported on the associations between ECC and maternal (n = 33), paternal (n = 3), and parental (n = 9) level of education, and 13 (26.7%) reported on the association between parental education and the severity of ECC. Mothers with more than primary school education (n = 3), post-secondary/college/tertiary education (n = 23), and more than 4-12 years of education (n = 12) had children with lower risk for ECC. Two studies reporting on parental education found an association between maternal but not paternal education and ECC. The review suggests that achieving the SDG 4.1 may reduce the risk of ECC. Possible pathways by which maternal education protects from ECC were feeding practices, oral hygiene practices, and the use of dental services. CONCLUSION: The study findings suggests that higher maternal educational level may reduce the risk for the consumption of cariogenic diet, poor oral hygiene practices and poor use of dental services for caries prevention. However, the association between paternal education and ECC was not consistently observed, with significant associations less frequently reported compared to maternal education. Future studies are needed to define the magnitude and modifiers of the impact of maternal education on the risk for ECC.

Ankyloglossia and Breastfeeding Duration: A Multicenter Birth Cohort Study.

Background and Objective: The prevalence of ankyloglossia and its impact on breastfeeding practices may be overestimated, leading to surgical overtreatment in newborns. The study was conducted to estimate the prevalence of ankyloglossia in the first year of life and investigate the association with exclusive and total breastfeeding duration in different regions of Brazil. Materials and Methods: This multicenter prospective cohort study involved the recruitment of mother-infant pairs soon after childbirth in public hospitals in three state capitals in Brazil. Interviews were held with the mothers after birth, at 6 and 12 months to collect sociodemographic variables and data on exclusive and total breastfeeding duration. At 12 months of age, the children were submitted to a dental examination for classification of the lingual frenulum using the Bristol Tongue Assessment Tool. Data analysis involved Poisson regression with robust variance, with the calculation of unadjusted and adjusted relative risk (RR). Results: The final sample was composed of 293 children. The prevalence of defined and suspected ankyloglossia was 1% and 4.8%, respectively, totaling 5.8% (confidence interval [95% CI]: 3.1-8.5). No significant difference was found in the prevalence of exclusive and total breastfeeding at 1, 4, and 6 months between children with defined/suspected ankyloglossia and those without ankyloglossia. The multivariable analysis showed that the probability of the child achieving 6 months of breastfeeding did not differ between groups (RR = 0.98; 95% CI: 0.79-1.23; p = 0.907). Conclusion: The prevalence of defined ankyloglossia was very low and defined/suspected ankyloglossia was not associated with exclusive or total breastfeeding duration. Clinical Trial Registration: Registered with clinicaltrials.gov (n° NCT03841123).

Early-life sugar consumption and breastfeeding practices: a multicenter initiative in Latin America.

The aim of this multicenter study was to explore the early-life sugar consumption and dietary practices in Latin America as well as to investigate the association between breastfeeding duration and the age at which foods and beverages with added sugars are introduced. A cross-sectional study was conducted with 805 1- to 3-year-old children from 10 Latin American countries, as a complementary study to the Research Observatory for Dental Caries of the Latin American Region (OICAL). A Food Frequency Questionnaire previously tested in different countries was applied to children's mothers and data on breastfeeding and age at introduction of sugary foods and beverages was collected. Statistical analysis included the Kruskal-Wallis test and Poisson regression with robust variance, with the calculation of crude and adjusted mean ratios (MR) and 95% of confidence intervals (CI). The average age at introduction of sugary foods and beverages was 10.1 months (95%CI 9.7-10.4) and 9.6 (95%CI 9.2-9.9) months, respectively, with a significant variation between countries (p < 0.001). The average daily frequency of sugary foods-beverages was 3.3 times per day (95%CI 3.1-3.5) and varied significantly between countries (p = 0.004). Breastfeeding duration of over six months was associated with an increase in the age of introduction of sweet drinks (16%; MR 1.16; 95%CI 1.05-1.28) and foods (21%; MR 1.21; 95%CI 1.10-1.33). In conclusion, most children from vulnerable settings in Latin America start consuming sugary products in the first year of life and a high frequency of consumption was reported through early childhood. Additionally, breastfeeding contributes to a delay in the introduction of sugary products.

Breastfeeding Protects from Overjet in Adolescence by Reducing Pacifier Use: A Birth Cohort Study.

Increased dental overjet in adolescence is a clinically relevant outcome associated with the complexity and high cost of treatment, indicating the need for prevention strategies. We investigated the long-term impact of breastfeeding and pacifier use on increased overjet (IOVJ) in permanent dentition. A prospective cohort nested in a randomized controlled trial was conducted from birth to 12 years of age (n = 214). Breastfeeding and pacifier use were recorded monthly until 12 months. Overjet was assessed at age 12 years. We employed a causal mediation analysis using parametric regression models assuming no interaction between breastfeeding and pacifier usage. We found a total protective effect of breastfeeding on IOVJ (OR 0.49; 95% CI 0.28-0.96), where 63.1% were mediated by pacifier use (OR 0.61; 95% CI 0.44-0.87). Breastfeeding directly decreased the odds of IOVJ by 20%; however, the confidence interval included the null estimate (OR 0.81; 95% CI 0.41-1.60). In conclusion, breastfeeding protects by half of the IOVJ in adolescence through reducing pacifier use. Oral and general health professionals should collaborate to support WHO breastfeeding guidelines during individual patient counseling. Guidelines for practice, policy or public information require messages that include a common risk approach to oral and general health.

A scoping review on the association of early childhood caries and maternal gender inequality.

AIM: The objective of this scoping review is to present current evidence regarding the association between early childhood caries (ECC) and maternal-related gender inequality. METHODS: Two independent reviewers performed a comprehensive literature search using three databases: EMBASE, PubMed, and Web of Science. Literature published in English from 2012 to 2022 was included in the search and was restricted to only primary research by using the following key terms: "dental caries", "tooth decay", "gender", "sex", "preschool", "toddler," and "infant". The included studies were limited to those reporting an association between ECC and maternal aspects related to gender inequality. Titles and abstracts were screened, and irrelevant publications were excluded. The full text of the remaining papers was retrieved and used to perform the review. The critical appraisal of selected studies was guided by the Joanna Briggs Institute (JBI) Critical Appraisal Tools. RESULTS: Among 1,103 studies from the three databases, 425 articles were identified based on publication years between 2012 and 2022. After full-text screening, five articles were included in the qualitative analysis for this review. No published study was found regarding a direct association between ECC and maternal gender inequality at the level of individuals. Five included studies reported on the association between ECC and potential maternal-gender-related inequality factors, including the mother's education level (n = 4), employment status (n = 1), and age (n = 1). Regarding the quality of the included studies, out of five, two studies met all JBI criteria, while three partially met the criteria. CONCLUSIONS: Based on the findings of this scoping review, evidence demonstrating an association between gender inequality and ECC is currently limited.

Primary Dentition Caries Patterns as Predictors of Permanent Dentition Caries: A Prospective Cohort Study.

The aims of this study were to estimate the risk of caries in the permanent teeth at 12 years of age and to describe the diagnostic accuracy of caries patterns in the primary dentition at age 4 years to predict caries at age 12 years. A prospective cohort study followed children from birth to age 12 years in the city of São Leopoldo, Brazil. Sociodemographic variables were collected at birth, and dental caries was measured at 4 and 12 years of age (n = 204). At 4 years, children were classified according to the presence of caries (cavitated and non-cavitated lesions), number of lesions, affected segment (anterior or posterior), and affected surface (occlusal, smooth, or proximal). Prediction of permanent dentition caries occurrence (DMFT ≥1) (primary outcome) involved Poisson regression with robust variance and standard diagnostic accuracy measures. The prevalences of caries at age 4 years (including non-cavitated lesions) and 12 years were 61.8% and 42.2%, respectively. All caries patterns in the primary dentition were associated with caries in the permanent dentition. In multivariable analysis, the strongest associations were carious lesions on the primary posterior teeth (RR 2.2; 95% CI 1.5-3.2) and occlusal surfaces (RR 2.1; 95% CI 1.4-3.0). Among patterns evaluated, the presence of any tooth with caries (cavitated or non-cavitated) had the highest sensitivity (73%), but any tooth with cavitated decay had the highest accuracy (67%). In conclusion, any dental caries experience in early childhood is strongly predictive of dental caries experience in early adolescence. Primary dentition carious lesions on the posterior teeth or occlusal surfaces and the presence of cavitated lesions were stronger predictors.

Early-life sugar consumption and breastfeeding practices: a multicenter initiative in Latin America

Abstract The aim of this multicenter study was to explore the early-life sugar consumption and dietary practices in Latin America as well as to investigate the association between breastfeeding duration and the age at which foods and beverages with added sugars are introduced. A cross-sectional study was conducted with 805 1- to 3-year-old children from 10 Latin American countries, as a complementary study to the Research Observatory for Dental Caries of the Latin American Region (OICAL). A Food Frequency Questionnaire previously tested in different countries was applied to children's mothers and data on breastfeeding and age at introduction of sugary foods and beverages was collected. Statistical analysis included the Kruskal-Wallis test and Poisson regression with robust variance, with the calculation of crude and adjusted mean ratios (MR) and 95% of confidence intervals (CI). The average age at introduction of sugary foods and beverages was 10.1 months (95%CI 9.7-10.4) and 9.6 (95%CI 9.2-9.9) months, respectively, with a significant variation between countries (p < 0.001). The average daily frequency of sugary foods-beverages was 3.3 times per day (95%CI 3.1-3.5) and varied significantly between countries (p = 0.004). Breastfeeding duration of over six months was associated with an increase in the age of introduction of sweet drinks (16%; MR 1.16; 95%CI 1.05-1.28) and foods (21%; MR 1.21; 95%CI 1.10-1.33). In conclusion, most children from vulnerable settings in Latin America start consuming sugary products in the first year of life and a high frequency of consumption was reported through early childhood. Additionally, breastfeeding contributes to a delay in the introduction of sugary products.

Pattern of caries lesions and oral health-related quality of life throughout early childhood: A birth cohort study.

The aim of this study was to evaluate the impact of different patterns of dental caries on oral health-related quality of life (OHRQoL) throughout early childhood. This birth cohort study followed 277 children from southern Brazil for 6 years. Demographic and socioeconomic variables were collected at birth. At age 3 years, children's dental caries experience was quantified by the decayed, missing, or filled teeth (dmft) index. At age 6 years, parents answered the Early Childhood Oral Health Impact Scale (ECOHIS). Poisson regression models were used to estimate associations between caries experience and later OHRQoL, presented as the ratio of ECOHIS scores between the groups. The prevalence of dental caries at 3 years of age was 37.5%. In children with caries, lesions only in anterior teeth, only in posterior teeth, and in both dental segments at age 3 were associated with age 6 ECOHIS scores that were 2.7, 7.8, and 6.2 times higher, respectively, than in children without dental caries experience. OHRQoL was worse among children with higher dmft scores. Dental caries lesions in posterior teeth by age 3 years was strongly predictive of adverse impacts on later OHRQoL, presumably as an indicator of continued disease experience in the intervening years.

Added Sugar and Oral Health: A Position Paper of the Brazilian Academy of Dentistry.

Excessive sugar consumption is the main cause of dental caries. Dental caries is highly prevalent and negatively impacts the quality of life at all stages. Furthermore, sugar consumption is associated with other noncommunicable conditions and diseases, such as obesity, diabetes, and cardiovascular diseases. The aim of this paper is to propose recommendations at the individual and population levels for health professionals, families, educators, stakeholders, and public officials to reduce the burden of dental caries and other noncommunicable diseases that are caused by the excessive sugar intake. A systematic search was performed in PubMed and Cochrane databases to investigate the effectiveness of strategies and policies aiming to reduce sugar consumption as well as the impact of different patterns of sugar consumption on the occurrence of dental caries. Reference list of the identified papers and practice guidelines were manually reviewed as well. Based on the best evidence available, the Brazilian Academy of Dentistry recommends not to offer sugars to children younger than 2 years of age, and to limit total sugar consumption to <25 g per day after 2 years of age. Furthermore, families should be informed to limit sugar exposure, sugar-free areas should be available, content of food labels and advertisement should be regulated, taxation of products with sugar should be introduced, and reformulation of foods and drinks to reduce concentrations of sugars should be considered.

Maxillary Labial Frenum in Preschool Children: Variations, Anomalies and Associated Factors.

OBJECTIVE: To investigate the prevalence of morphological and attachment variations of the maxillary labial frenum (MLF) and associated factors in preschool children. STUDY DESIGN: A cross-sectional study was conducted with 1,313 children aged between zero and five years of age attending public nurseries in the city of Canoas in southern Brazil. Data were collected through a questionnaire addressing demographic, socioeconomic, and behavioral characteristics and a clinical examination of the MLF. Assessments of MLF morphology and attachment were based on the classification systems proposed by Sewerin and Mirko et al., respectively. RESULTS: The most prevalent patterns were simple MLF (63.8%) and gingival attachment (51.1%). Morphological abnormalities were found in 21.6% of the preschoolers and 25.4% exhibited abnormal frenal attachment. Abnormalities in MLF morphology were more prevalent among girls (p = 0.003) and a significant reduction was found with the increase in age (p < 0.001). Attachment abnormalities were significantly more prevalent among girls (p < 0.001), the white ethnic group (p = 0.005), and children who used a pacifier (p = 0.007) and also reduced significantly with the increase in age (p < 0.001). CONCLUSION: Demographic and behavioral characteristics were associated with MLF morphology and attachment. The reduction in the prevalence of the outcomes with the increase in age suggests that surgical interventions in the first years of life may constitute overtreatment.

Early-Life Patterns of Sugar Consumption and Dental Caries in the Permanent Teeth: A Birth Cohort Study.

Early-life family conditions may presage caries development in childhood. The aim of this study was to evaluate associations between patterns of sugar consumption in early childhood and permanent dentition caries at age 6 years. A cohort enrolled women accessing prenatal care at public health clinics in Porto Alegre, Brazil. Sociodemographic, anthropometric, and dietary data were collected during pregnancy and 6-month, 12-month, and 3-year follow-ups. Calibrated dental examinations occurred at ages 3 and 6 years. Multivariable logistic regression analysis was performed in series to quantify associations between early-life variables and permanent dentition caries. At age 6 years, 7.9% of children (21/266) had ≥1 caries lesion on permanent teeth (first molars). In unadjusted models, gestational weight gain, sweet food introduction (age 6 months), household sugar purchases (age 3 years), and caries (age 3 years) were positively associated with permanent dentition caries (age 6 years). In multivariable models, each 1-kg increase in gestational weight gain (odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.01, 1.16) and each 1-item increase in sweet food consumption at age 6 months (OR: 1.27; 95% CI: 1.02, 1.59) remained statistically significantly associated with permanent molar caries. Findings from this cohort study suggest family and child factors that long predate the permanent dentition, including sugar-related behaviors, predict future dental status, and may inform prevention strategies.

Primary Health Care Intervention Reduces Added Sugars Consumption During Childhood.

OBJECTIVE: To investigate the effectiveness of a training program for health workers regarding infant feeding practices to reduce sugar consumption in children. DESIGN: A cluster randomized trial was conducted at 20 health centers in southern Brazil randomly assigned to an intervention (n = 9) or control (n = 11) group. PARTICIPANTS: The 715 pregnant women enrolled were assessed when their children were aged 6 months, 3 years, and 6 years. INTERVENTION: A training session for primary care workers based on the Brazilian National Guidelines for Children. MAIN OUTCOME MEASURE: Mothers were asked when sugar was first offered to children. Added sugars intake was obtained from dietary recalls. ANALYSIS: The effectiveness of the intervention was modeled using generalized estimation equations and Poisson regression with robust variance. RESULTS: Children attending intervention health centers had a 27% reduced risk of sugar introduction before 4 months of age (relative risk, 0.73; 95% confidence interval [CI], 0.61-0.87) as well as lower added sugars consumption (difference, -6.36 g/d; 95% CI, -11.49 to -1.23) and total daily energy intake (difference, -116.90 kcal/d; 95% CI, -222.41 to -11.40) at 3 years of age. CONCLUSIONS AND IMPLICATIONS: Health care worker training in infant feeding guidelines may be an effective intervention to delay the introduction of added sugars and lower the subsequent intake of added sugars in infants and toddlers.

Association between crack cocaine use and dental caries experience: a cross-sectional study in southern Brazil.

The aim of the present study was to compare the prevalence of dental caries between crack cocaine users and a control group. The study included 106 participants in each group matched for age, sex, and exposure to tobacco. Crack cocaine users were selected from institutions for the treatment of chemical dependency, and the control group was recruited from a public school and among patients who sought dental care. A calibrated examiner determined dental caries experience [Decayed, Missing and Filled Teeth (DMFT) index]. The severity of tooth decay was determined using the Significant Caries Index (SiC). The prevalence of dental caries (DMFT ≥ 1) was 96.2 and 81.1% among the crack cocaine users and nonusers, respectively. Crack users had higher mean DMFT values (7.16 versus 4.92) for the decayed and missing components as well as a higher percentage of individuals with highly severe caries compared to nonusers. After the adjustments in the multivariate model, the prevalence of caries was 18% higher among the crack users (prevalence ratio: 1.18; 95% confidence interval: 1.08-1.30). Age, family income, crack cocaine use, and dental calculus were associated with the occurrence of dental caries. In conclusion, the prevalence of caries was higher among the crack users compared with the control group and remained associated with dental caries in the multivariate analysis.

Risk factors for dental caries in Latin American and Caribbean countries.

Identifying the risk factors for dental caries is vital in epidemiology and clinical practices for developing effective preventive strategies, both, at the individual and collective levels. Different causality/determination models have been proposed to understand the development process of dental caries. In the present review, we designed a model inspired by the world-known social determinants models proposed in the 90s and more recently in the 10s, wherein the contextual factors are placed more externally and encompass the individual factors. The contextual factors included those related to the cultural and societal values, as well as the social and health government policies. The individual factors were classified into the following categories: socioeconomic (social class, occupation, income, and education level), demographic characteristics (age, sex, and ethnicity), behavioral factors (non-use of fluoride dentifrice, sugar consumption, poor oral hygiene, and lack of preventive dental care), and biological factors (recent caries experience/active caries lesions, biofilm retentive factors, developmental defects of the enamel, disabilities, saliva amount and quality, cariogenic biofilm). Each of these variables was addressed, while focusing on the current evidence from studies conducted in Latin American and Caribbean countries (LACC). Based on the proposed model, educational aspects were addressed, and individual caries risk assessment and management decisions were proposed; further, implications for public health policies and clinical practice were described. The identification of modifiable risk factors for dental caries should be the basis for multi-strategy actions that consider the diversity of Latin American communities.

An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries.

BACKGROUND: Universal health care (UHC) may assist families whose children are most prone to early childhood caries (ECC) in accessing dental treatment and prevention. The purpose of this study was to determine the association between UHC, health expenditure and the global prevalence of ECC. METHODS: Health expenditure as percentage of gross domestic product, UHC service coverage index, and the percentage of 3-5-year-old children with ECC were compared among countries with various income levels using one-way analysis of variance (ANOVA). Three linear regression models were developed, and each was adjusted for the country income level with the prevalence of ECC in 3-5-year-old children being the dependent variable. In model 1, UHC service coverage index was the independent variable whereas in model 2, the independent variable was the health expenditure as percentage of GDP. Model 3 included both independent variables together. Regression coefficients (B), 95% confidence intervals (CIs), P values, and partial eta squared (ƞ2) as measure of effect size were calculated. RESULTS: Linear regression including both independent factors revealed that health expenditure as percentage of GDP (P < 0.0001) was significantly associated with the percentage of ECC in 3-5-year-old children while UHC service coverage index was not significantly associated with the prevalence of ECC (P = 0.05). Every 1% increase in GDP allocated to health expenditure was associated with a 3.7% lower percentage of children with ECC (B = - 3.71, 95% CI: - 5.51, - 1.91). UHC service coverage index was not associated with the percentage of children with ECC (B = 0.61, 95% CI: - 0.01, 1.23). The impact of health expenditure on the prevalence of ECC was stronger than that of UHC coverage on the prevalence of ECC (ƞ2 = 0.18 vs. 0.05). CONCLUSIONS: Higher expenditure on health care may be associated with lower prevalence of ECC and may be a more viable approach to reducing early childhood oral health disparities than UHC alone. The findings suggest that currently, UHC is weakly associated with lower global prevalence of ECC.

Socioeconomic and intraoral polarization of untreated caries and tooth loss among male adolescents.

The aim of this study was to investigate the intraoral distribution of untreated caries and tooth loss and estimate the impact of different socioeconomic factors on the occurrence of these outcomes. A cross-sectional study was conducted with 652 18-year-old male adolescents from the city of Sapucaia do Sul, Brazil, who conscripted for military service. The participants answered a questionnaire addressing sociodemographic variables. Two trained and calibrated examiners performed the clinical examinations for the diagnosis of dental caries using the criteria of the World Health Organization. Tooth group and adolescent were the units of analysis for the primary outcomes of the study. Poisson regression analysis with robust variance was performed, with the calculation of crude and adjusted prevalence ratios (PR) and 95% confidence intervals (CI). The prevalence of caries experience and untreated caries was 70.2% and 39.3%, respectively, and 9.4% of the adolescents had missing teeth. Sixty-seven percent of the untreated caries and 98.8% of missing teeth were in first molars. The probability of dental caries and tooth loss was significantly higher among adolescents with less schooling (PR = 2.56; 95%CI: 1.97-3.32 and PR = 3.28; 95%CI: 1.61-6.65, respectively) and those whose mothers had less schooling (PR = 1.31; 95%CI: 1.03-1.67 and PR = 2.30; 95%CI: 1.18-4.50, respectively). In conclusion, the occurrence of untreated dental caries and tooth loss was concentrated in the first molars of adolescents. Moreover, the prevalence of both conditions was higher among adolescents with low schooling and whose mothers had low schooling, reflecting the strong intraoral and socioeconomic polarization of these outcomes.

Use of crack cocaine increases tooth loss.

PURPOSE: To evaluate the occurrence of tooth loss among crack cocaine users. METHODS: A cross-sectional study was conducted with 106 crack cocaine users and 106 controls matched for age, gender, and tobacco use. Data were collected on socio-demographic characteristics, drug use, use of dental services, dental caries, periodontal disease, and the outcome (tooth loss). RESULTS: Crack cocaine users had a greater frequency of tooth loss (55.7% vs. 36.8%), severity of dental caries and periodontal disease and less use of dental services than the controls (P< 0.05). After adjustments, tooth loss was 46% more frequent among crack cocaine users (PR= 1.46; 95%, CI: 1.10-1.93) as well as significantly more frequent among non-whites, those older than 24 years of age and those with high dental caries severity. Occurrence of tooth loss was significantly higher among crack cocaine users. These findings can contribute to the planning and implementation of prevention strategies and oral health care for individuals with a chemical dependence. CLINICAL SIGNIFICANCE: The use of crack cocaine had a negative impact on the oral health of its users, leading to tooth loss and a greater severity of dental caries. These findings should be considered when planning prevention strategies to improve oral health in individuals addicted to crack cocaine.

Exploring the risk factors for early-life sugar consumption: A birth cohort study.

BACKGROUND: Sugar consumption in early childhood is the primary cause of negative health outcomes, including early childhood caries. AIM: To investigate risk factors associated with early-life sugar consumption. DESIGN: Explanatory variables were collected at baseline of a birth cohort in Porto Alegre, Southern Brazil. At six months of age, data were collected on child feeding practices, including the number of foods and beverages containing sugar. Multivariate Poisson regression analysis with robust variance was performed. RESULTS: Virtually all children (98.3%) had consumed sugar by the age of 6 months. Multivariable analysis showed that the number of sweet items was significantly larger in children whose mothers were less than 20 years of age (MR = 1.19; 95% CI: 1.05-1.36), those from non-nuclear families (MR = 1.12; 95% CI: 1.04-1.20), those whose mothers had less than eight years of schooling (MR = 1.34; 95% CI: 1.20-1.50) and those whose mothers smoked (MR = 1.23; 95% CI: 1.13-1.35). Moreover, the number of sweet items was significantly lower among children who breastfed in the first hour of life (MR = 0.85; 95% CI: 0.76-0.95). CONCLUSION: Sugar consumption begins very early, especially in children with no access to breastfeeding in the first hours of life and those from younger, less educated, and smoking mothers.