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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Oral Health 1/2015

Association between added sugar intake and dental caries in Yup’ik children using a novel hair biomarker

BMC Oral Health > Ausgabe 1/2015
Donald L. Chi, Scarlett Hopkins, Diane O’Brien, Lloyd Mancl, Eliza Orr, Dane Lenaker
Wichtige Hinweise

Competing interests

The authors declare no competing interests.

Authors’ contributions

DLC conceptualized the study, collected data, conducted the dental exams, and wrote the first draft of the manuscript. SH conceptualized the study, collected data, and helped revise the manuscript. DO conceptualized the study, processed and interpreted the biomarker data, and helped revise the manuscript. LM conceptualized the study, analyzed the biomarker and dental caries data, and helped revise the manuscript. EO collected data, interpreted study findings, and helped revised the manuscript. DL conceptualized the study, helped interpret study findings, and helped revised the manuscript. All authors read and approved the final manuscript.



Dental caries (tooth decay) is a significant public health problem in Alaska Native children. Dietary added sugars are considered one of the main risk factors. In this cross-sectional pilot study, we used a validated hair-based biomarker to measure added sugar intake in Alaska Native Yup’ik children ages 6–17 years (N = 51). We hypothesized that added sugar intake would be positively associated with tooth decay.


A 66-item parent survey was administered, a hair sample was collected from each child, and a dental exam was conducted. Added sugar intake (grams/day) was measured from hair samples using a linear combination of carbon and nitrogen ratios. We used linear and log-linear regression models with robust standard errors to test our hypothesis that children with higher added sugar intake would have a higher proportion of carious tooth surfaces.


The mean proportion of carious tooth surfaces was 30.8 % (standard deviation: 23.2 %). Hair biomarker-based added sugar intake was associated with absolute (6.4 %; 95 % CI: 1.2 %, 11.6 %; P = .02) and relative increases in the proportion of carious tooth surfaces (24.2 %; 95 % CI: 10.6 %, 39.4 %; P < .01). There were no associations between self-reported measures of sugar-sweetened food and beverage intake and tooth decay.


Added sugar intake as assessed by hair biomarker was significantly and positively associated with tooth decay in our sample of Yup’ik children. Self-reported dietary measures were not associated tooth decay. Most added sugars were from sugar-sweetened fruit drinks consumed at home. Future dietary interventions aimed at improving the oral health of Alaska Native children should consider use of objective biomarkers to assess and measure changes in home-based added sugar intake, particularly sugar-sweetened fruit drinks.
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