High Obesity, Caries Documented in Homeless Children

Laird Harrison

November 21, 2012

Homeless children have higher rates of caries and obesity than children in the general population, a new study shows.

The study, published online November 13 in the Journal of Pediatric Healthcare, showed that rates of caries among children living in shelters for the homeless increased with body mass index (BMI), but this correlation did not reach statistical significance (P = .08).

The researchers speculated that similar dietary factors might contribute to both caries and obesity. "Poor kids don't have access to nutritious foods," Marguerite DiMarco, PhD, RN, CPNP, told Medscape Medical News.

DiMarco said she had spent decades working with very poor children. "Some families don't even have a refrigerator to keep milk," she said. "Some families might not even have running water."

Some homeless children depend on convenience stores and fast-food restaurants as sources of food, she said.

Obesity is increasing among children. The percentage of children who are obese has more than doubled since 1980, the researchers reported. And caries is a common disease among children, afflicting more than 25% of children aged 2 to 5 years and 50% of children aged 12 to 15 years.

Although many children have both caries and obesity, researchers so far have reported contradictory findings about the relationship of these conditions.

Caries rates are extremely high among homeless children, higher even than among poor children who live in houses, DiMarco and her colleagues reported.

Poor oral health affects diet and nutrition and can lead to deficits in growth, speech, and learning, they said.

In effort to learn more about obesity and caries in homeless children, the researchers surveyed a population of 157 children aged 2 to 17 years living in an Ohio shelter. Sixty-four percent of the children were black, 34% were white, and 2% were Hispanic or other ethnicity. Most children were in families headed by a woman in her twenties.

The researchers measured the children's BMI and classified them as obese if they were above 95% on the Centers for Disease Control and Prevention BMI Tool for Schools.

They measured caries by using the Visual Screening for Evaluating Oral Health Status in Children.

They found that 30.6% of the children were obese and 50.3% had caries. The rates are higher than those reported for the United States as a whole: In those reports, about a quarter of children aged 2 to 5 years have had caries, about a fifth have untreated caries, and 16.3% are obese.

DiMarco and her colleagues found that BMI percentile increased with age in the homeless children: from 74.1% at age 2 to 6 years to 76.8% at age 12 to 17 years.

They found a statistically significant positive correlation between age and BMI percentile (P = .03) and between age and caries score (P = .003).

However, the researchers did not find a statistically significant correlation between caries and BMI (r = 0.14; P = .08).

The authors acknowledged as a weakness of their study that they did not control for other variables, such as nutrition.

Previous research has found that increased consumption of highly sweetened drinks and habitual use of caffeine can contribute to both obesity and caries.

But the relationship of diet to both obesity and caries is "difficult to analyze," dietitian Teresa A. Marshall, PhD, told Medscape Medical News in an email.

"This is interesting preliminary data based on a limited number of subjects," said Marshall, an associate professor in the Department of Preventive and Community Dentistry at the University of Iowa in Iowa City, who was not involved in this study.

"I hope these researchers continue investigation with additional subjects where they are able to compare caries rates between normal, overweight and obese children."