Diet Control Program through the Cariogenic Potentiality Index for Adult

Transcription

1 Original Article Int J Clin Prev Dent 2016;12(3): ㆍ ISSN (Print) ㆍ ISSN (Online) Diet Control Program through the Cariogenic Potentiality Index for Adult Su-Hyun Shim Department of Dental Hygiene, Kyungbok University, Namyangju, Korea Objective: Caries prevention through the diet control can be achieved clinically by use of the computer program. This program analyzes the nutrient and cariogenic potentiality for a range of food commonly eaten by the average Korean adult. Methods: Seventy volunteers between the age of 20 and 30 years participated in the clinical experiment. Participants were asked to record 5 consecutive days of dietary intake. Using the diet control program established by the cariogenic potentiality indices, we were able to determine an individual participants average nutritional intake over the course of five days (calory, basic nutrient, cariogenic potentiality, sodium intake for a day, individually, were revealed from the computer program). In addition to such average data, we also know whether excess or deficiency for each item. And the correlation between the intake of foods and the oral status for caries experience in subjects, were revealed. Results: The average calory of the subjects was revealed as 2,082.52± kcal/day as included in the recommendation level for Korean adults. But the average intake of sodium was 4,618.02±1, mg/day, it was significantly higher than the recommended daily requirements (1,500-2,000 mg) in Korean adults. Basic nutrient amounts for carbohydrate, protein, fat were within the recommendation level, as well as the clean food. The average cariogenic potentiality index was estimated as ±47.49 minutes. Conclusion: Computer program for analysis of each nutrient using the cariogenic potentiality index was considered as useful tool for diet therapy in clinical preventive dentistry. Keywords: cariogenic diet, cariogenic potential index, dental caries, diet therapy Introduction The etiology of dental caries has been known as the multi-factorial disease which would be influenced such factors as oral Corresponding author Su-Hyun Shim Department of Dental Hygiene, Kyungbok University, 425 Jinjeop-eup, Namyangju, Korea. Tel: , Fax: , noblige121@naver.com Received August 18, 2016, Revised August 31, 2016, Accepted September 2, 2016 micro-organism in the dental plaque, sugar contained diet, salivary action and tooth defense mechanism [1]. Fortunately the incidence of dental caries in advanced countries has been decreased in recent years while increased in the developing countries [2,3]. It has been common in dental field that plaque control, fluoride application, pit & fissure sealing, and diet control is effective in clinical prevention of caries. Among them, diet control has been the last to be selected because it s a difficult method to be applied in dental clinic, except warning the cariogenic food for dental patient. The principle of the diet control for dental caries prevention is reducing the amounts and the frequency of the cariogenic Copyright c Korean Academy of Preventive Dentistry. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 137

2 International Journal of Clinical Preventive Dentistry foods and prescribing proper foods instead. It is a kind of control method for environmental causative factors of the dental caries. It was introduced that the sugar consumption less than 10 kg a year (30 g of sugar a day) could maintain the low level of the caries incidence while the sugar consumption more than 15 kg a year could cause rapid rise in the dental caries incidence [4]. Moreover, the diet control in clinical level was recommended as the effective method for caries prevention, especially in rampant caries [5]. So far the researches about cariogenic food, cariogenic potentiality are insufficient in Korea [6]. The cariogenic potentiality is influenced by the sugar contents and the viscosity of food. Therefore we investigated the caries potentiality index for the 278 foods which was popular in Korea, today. In addition, we developed the computer program suggesting the proper food for adults. This computer program analyzes an individual participants average nutritional intake over the course of five days (calory, basic nutrient, cariogenic potentiality, sodium intake for a day). On top of that, patients could also know whether excess or deficiency for each item using this program. Therefore this diet control program would be useful in clinical preventive dentistry. The aim of this study is to develop and evaluate the computerized diet control program using the cariogenic potentiality index for adult patients in dental clinic. Materials and Methods 1. Materials Two hundred and seventy-eight favorite foods for Korean adults were examined for the caries potentiality index. The cariogenic potentiality index of each food could be calculated with the sugar contents and the viscosity of each food applying the regression analysis on the variables. The sugar content of each food was measured by the use of the glucosetester (PAL-1; ATAGO Co., Ltd., Tokyo, Japan) and the viscosity of each food was examined with the number 1 spindle of the rotation viscometer (NDJ-8S; Shanghai Nirun Intelligent Technology Co., Ltd., Shanghai, China) in 60 rpm (Figure 1, 2). The sugar contents and the viscosity of each food were tested for 3 times after 3 minutes mixing the food with the electric mixer (BRAUN MX-2050; P&G Co., Ltd., Cincinnati, OH, USA) in 10% dilution. In case of solid foods, 40 g of them were diluted with 400 ml water. The sugar contents and the viscosity of each food sample were measured at a temperature of 24 o C to 27 o C. The cariogenic potentiality index for each food could be calculated by the use of the constant which was estimated as for sugar contents and for the viscosity through the experimental and statistical analysis (regression model) [7]. The formula of the cariogenic potentiality index was as below. Cariogenic potentiality index= sugar contents viscosity 2. Subjects Seventy volunteers between the age of 20 and 30 years participated in the clinical experiment to evaluate the diet control program. This project was submitted to and approved by the Dankook University Institutional Review Board, document no All participants signed an informed consent form. The age and the gender distribution were shown in Table 1. Figure 1. Glucosetester (ATAGO PAL-1). Figure 2. Rotation Viscometer (Shanghai Nirun Intelligent Technology Co., Ltd, NDJ-8S). 138 Vol. 12, No. 3, September 2016

3 Su-Hyun Shim:Diet Control Program through the Cariogenic Potentiality Index for Adult 3. Methods The data of the nutrient for each food from Korean Ministry of Food and Drug Safety, Korean Nutrition Society and the cariogenic potentiality index for each food were put into the computer program [8]. Computer program included such factors as the intake of each food (g), energy calory (kcal), Natrium amounts (mg), carbohydrate (g), protein (g), fat (g), and cholesterol (mg) per day, also (Table 2). The computer program was developed by the use of such general program as Window 7.0, CPU intel i7, Microsoft Excel ver. 2007, (Microsoft, Redmond, WA, USA), Visual studio 2010 (C++), Graphic editor. Seventy volunteers between the age of 20 and 30 years participated in the clinical experiment to make the guideline for this diet control program. Participants were asked to input sex, age, Table 1. Sex and age distribution of subjective Age group (yr) Total (n) Male Gender (n) Female Total height, weight and 5 consecutive days of dietary intake. Besides, this program offered one of three options to participants in the amounts of food intake: much, moderate, less. In case of no food intake, participants had to click the No button. Then, participants could receive the prescription for the proper diet individually. It could be printed as an outcome. The proper calory range a day was evaluated by the application of the original Harris-Benedict equations published in 1919 (Table 3). The computer program decides proper calory from basal metabolic rate (BMR) 1.2 to BMR 1.9 individually [9]. Using this diet control program established by the cariogenic potentiality indices, we were able to determine an individual participants average nutritional intake over the course of five days (calory, basic nutrient, cariogenic potentiality, sodium intake for a day, individually, were revealed from the computer program). In addition to such average data, participants could also know whether excess or deficiency for each item. This program was designed to suggest the standardization for nutrition to dental patients according to the age, gender, the height, the body weight and the daily diet. In the program, the frequency of daily detergent food intake was recommended as more than 2 twice a day and the comprehensive caries potentiality index for daily total food intake was designed as the sum of the individual caries potentiality index. And the cariogenic potentiality index a day was total time (minutes) when dental pa- Table 2. Outline of the diet control program Input Output (daily average) Reference 1. Sex 1. Calory The original Harris-Benedict equations published in Age 2. Intake of C, P, F Dietary reference intakes for Koreans Height 3. Intake of Vit, M Dietary reference intakes for Koreans Weight 4. Intake of Na Dietary reference intakes for Koreans Diet menu 5. Intake of detergent food 6. Cariogenic potentiality index C: carbohydrate, P: protein, F: fat, Vit: vitamin, M: minerals, Na: sodium. Table 3. The original Harris-Benedict equations published in 1919 Variable BMR BMR calculation for men (metric) BMR calculation for women (metric) Daily energy expenditure Little exercise Light exercise (1-3 days per week) Moderate exercise (3-5 days per week) Heavy exercise (6-7 days per week) Very heavy exercise (twice per day, extra heavy workouts) Equation BMR=66.5+(13.75 weight in kg)+(5.003 height in cm) (6.755 age in years) BMR=655.1+(9.563 weight in kg)+(1.850 height in cm) (4.676 age in years) BMR 1.2 BMR BMR 1.55 BMR BMR 1.9 BMR: basal metabolic rate

4 International Journal of Clinical Preventive Dentistry tients were expected to be exposed in the cariogenic environment for a day. The program sample was shown in Figure 3, 4. Moreover, in this program total time exposed to the cariogenic environment a day was expressed in the prescription so as to change the food choice for caries prevention easily. Then we carried out simplified-patient hygiene performance index, Snyder test in all subjects in order to estimate the correlation between the factors of eating habits and the factors developing dental caries. SPSS Statistics ver (SPSS Inc., Chicago IL, USA) was used for data analysis and the significance level was p<0.05 with Pearson correlation coefficient. Results 1. Daily eating habits for adults Daily eating habits for adults were investigated (Table 4). 2. Average value of the factors developing dental caries Average value of the factors developing dental caries for adults was investigated (Table 5). 3. Correlation between the factors of eating habits Figure 3. Computerized diet program for Korean adults. Correlation between the factors of eating habits was investigated (Table 6-8). Figure 4. Computerized diet prescription. Table 4. Daily eating habits for adults (n=70) Item Mean±standard deviation Recommended daily requirements a Calory (kcal) 2,082.52± ,800-2,600 C (g) ± (55%-70% of C, P, F) P (g) 82.67± (7%-20% of C, P, F) F (g) 74.03± (15%-25% of C, P, F) Detergent food (number of intake) 1.89± Sodium (mg/d) 4,618.02±1, ,500-2,000 C: carbohydrate, P: protein, F: fat. a Dietary reference intakes for Koreans 2010 published by Korean Nutrition Society. 140 Vol. 12, No. 3, September 2016

5 Su-Hyun Shim:Diet Control Program through the Cariogenic Potentiality Index for Adult 4. Correlation between the factors developing dental caries Correlation between the factors developing dental caries was investigated (Table 9-11). Table 5. Average value of the factors developing dental caries (n=70) item Mean±standard deviation CPI (min) ±47.49 s-php 1.04±0.62 Snyder test a 1.19±0.94 DT 0.84±1.87 DS 0.86±1.91 FT 4.51±3.23 FS 6.93±5.59 DFT 5.36±3.53 DFS 7.79±5.59 CPI: cariogenic potentiality index, s-php: simplified patient hygiene performance index, DT: decayed tooth,ds: decayed surface, FT: filled tooth, FS: filled surface, DFT: decayed filled tooth, DFS: decayed filled surface. a 0: inactive, 1: slight active, 2: moderate active, 3: highly active. 5. Correlation between the factors of eating habits and the factors developing dental caries Correlation between the factors of eating habits and the factors developing dental caries was investigated (Table 12). Discussion Dental caries occurred with the eroded tooth surface from the acid product of oral micro-organism which would take in sugar through the carbohydrate food [1]. So the diet control has been introduced as one of the important methods for the prevention of dental caries. Even though the diet control was a very important and effective way to control the caries, it has been neglected clinically. Because of the limitation in application, only the oral health education for the diet control has been performed. But recent advances in computers makes it possible to apply the diet control program effectively. It would be an easy guide for the cariogenic food. And the program could show the calory, basic nutrient, cariogenic potentiality and sodium intake for a day also. Caries potentiality was calculated with the sugar con- Table 6. Correlation between the factors of eating habits I (n=70) Variable Subheading Age Height Weight Calory Carbohydrate Age r - p Height r p Weight r ** - p Calory r p Carbohydrate r ** - p *p<0.05; **p<0.01. Table 7. Correlation between the factors of eating habits II (n=70) Variable Subheading Age Height Weight Calory Carbohydrate Protein r ** 0.374** p Fat r ** 0.263* p Vit/minerals r p Sodium r ** 0.423** p Detergent food r ** 0.313** p Vit: vitamin. *p<0.05; **p<

6 International Journal of Clinical Preventive Dentistry Table 8. Correlation between the factors of eating habits III (n=70) Variable Subheading Protein Fat Vit/minerals Sodium Detergent food Protein r - p Fat r 0.682** - p 0 Vit/minerals r 0.294* p Sodium r 0.48** 0.432** p Detergent food r 0.394** 0.27* 0.874** 0.266* - p Vit: vitamin. *p<0.05; **p<0.01. Table 9. Correlation between the factors developing dental caries I (n=70) Variable Subheading Snyder test a s-php CPI (min) CPI (step) b DT DS Snyder test a r - p s-php r p CPI (min) r p CPI (step) b r ** - p DT r 0.273* p DS r 0.274* ** - p s-php: simplified patient hygiene performance index, CPI: cariogenic potentiality index, DT: decayed tooth, DS: decayed surface. *p<0.05; **p< a 0: inactive, 1: slight active, 2: moderate active, 3: highly active. b CPI step: 1, 0-90 minutes; 2, minutes; 3, minutes; 4, 201 minutes. Table 10. Correlation between the factors developing dental caries II (n=70) Variable Subheading Snyder test a s-php CPI (min) CPI (step) b DT DS MT r p MS r p FT r p FS r * p DFT r 0.322** 0.236* ** 0.418** p DFS r 0.293* 0.29* p s-php: simplified patient hygiene performance index, CPI: cariogenic potentiality index, DT: decayed tooth, DS: decayed surface, MT: missing tooth, MS: missing surface, FT: filled tooth, FS: filled surface, DFT: decayed filled tooth, DFS: decayed filled surface. *p<0.05; **p<0.01. a 0: inactive, 1: slight active, 2: moderate active, 3: highly active. b CPI step: 1, 0-90 minutes; 2, minutes; 3, minutes; 4, 201 minutes. 142 Vol. 12, No. 3, September 2016

7 Su-Hyun Shim:Diet Control Program through the Cariogenic Potentiality Index for Adult Table 11. Correlation between the factors developing dental caries III (n=70) Variable Subheading MT MS FT FS DFT DFS MT r - p MS r 1** - p 0 FT r p FS r ** - p DFT r ** 0.724** - p DFS r ** 0.941** 0.866** - p MT: missing tooth, MS: missing surface, FT: filled tooth, FS: filled surface, DFT: decayed filled tooth, DFS: decayed filled surface. **p<0.01. Table 12. Correlation between the factors of eating habits and the factors developing dental caries (n=70) Variable Subheading Age Height Weight Calory Carbohydrate Protein Fat Vit/minerals Sodium Detergent food Snyder test a r * p s-php r p CPI (min) r ** 0.305* 0.477** 0.325** 0.474** 0.388** 0.533** p CPI (step) b r ** 0.289* 0.478** 0.44** 0.389** 0.361** 0.421** p DT r * p DS r * p MT r * p MS r * p FT r p FS r p DFT r p DFS r p Vit: vitamin, s-php: simplified patient hygiene performance index, CPI: cariogenic potentiality index, DT: decayed tooth,ds: decayed surface, MT: missing tooth, MS: missing surface, FT: filled tooth, FS: filled surface, DFT: decayed filled tooth, DFS: decayed filled surface. *p<0.05; **p<0.01. a 0: inactive, 1: slight active, 2: moderate active, 3: highly active. b CPI step: 1, 0-90 minutes; 2, minutes; 3, minutes; 4 201, minutes. tents and the viscosity of each food relatively. After developing the program, we evaluated the program with seventy volunteers between the age of 20 and 30 years. It s because the main reason for extraction of permanent teeth in Korea would be dental caries in this age group [10]. From the study, the average calory of the subjects was revealed as 2,082.52± kcal as included in the recommendation level for Korean adults. But the average sodium intake was 4,618.02±1, mg/day. It was significantly higher than the recommended daily requirements (1,500-2,000 mg) in 143

8 International Journal of Clinical Preventive Dentistry Korean adults. Excess Natrium intake could cause the cardiovascular disease [11,12], kidney disease and osteoporosis [13]. The results were similar to Korean average Natrium intake [14]. That s more than twice daily Natrium consumption, recommended by World Health Organization and Food and Agriculture Organization. So, it would be recommended to reduce the consumption of Natrium for the health as well as sugar consumption for the caries prevention in Korea. From the results, the average caries potentiality index for young adults was estimated as ±47.49 minutes a day. This value would be considered as the relative time exposed in the cariogenic food. And it was based on the former researches [6,7]. Correlation between the factors of eating habits such as carbohydrate, protein, fat, vitamin, mineral Natrium, and the frequency of the daily intake of the vegetable or the fruits was seen in Table 6-8. As a result, the calory was increased with all of nutrients. Snyder test was performed for all subjects also. There was close correlation between the results of Snyder test and such caries related factors as the number of decayed, filled tooth (Table 9-11). But there was no correlation between the cariogenic potentiality index and the factors of eating habits for young adults (Table 12). It means that the cariogenic food intake is not so much related with the number of dental caries, dental plaque deposition in young adults. But in old people, the prevalence of dental caries might increase again because of their root or cervical caries. So the diet control should be emphasized for elderly people, also. Furthermore in children and adolescents, dentists should focus the diet control program considering of their high prevalence of dental caries. This research would be used as database in the computer program which analyzes people s diet and recommends the customized prescriptions. Through this evaluation, the program was proved as useful tool of diet control clinically. In the future, we expect this program would be corrected continually for data upgrade. Conclusion The author has developed the computerized diet control program to help dental patients for caries prevention and applied it for seventy volunteers between the age of 20 and 30 years to estimate an individual participants average nutritional intake over the course of five days (calory, basic nutrient, cariogenic potentiality, sodium intake for a day, individually, were revealed from the computer program). In addition to such average data, participants could also know whether excess or deficiency for each item using this program established by the cariogenic potentiality indices. Moreover this study investigated the correlation between the intake of foods and the oral status for caries experience in subjects. The obtained results were as follows. 1. The average calory of the subjects was revealed as 2,082.52± kcal as included in the recommendation level for Korean adults. But the average intake of sodium was 4,618.02±1, mg/day. It was significantly higher than the recommended daily requirements (1,500-2,000 mg/day) in Korean adults. 2. Basic nutrient level for carbohydrate, protein, fat were within the recommendation level, as well as the detergent food. (276.78±94.81 g for carbohydrate, 82.67±27.68 g for protein, 74.03±28.45 g for fat, 1.89 ±1.28 times for the frequency of the detergent food in a day). 3. The average cariogenic potentiality index for young adults was estimated as ±47.49 minutes. 4. Computer program through the cariogenic potentiality index was proved as a useful tool for the analysis of each nutrient and the diet control in clinical preventive dentistry. References 1. Lee EJ, Hwang IK, Jin BH, Paik DI. Correlation between snack food intakes and dental caries in elementary school children. 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Assessment of physical activity pattern, activity coefficient, basal metabolic rate and daily energy expenditure in female university students. Korean J Community Nutr 2013;18: Ha JE, Bae KH. Reasons for extraction of permanent teeth in Korea. J Korean Acad Oral Health 2012;36: Strazzullo P, D Elia L, Kandala NB, Cappuccio FP. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ 2009;339:b Vol. 12, No. 3, September 2016

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