Sociodemographic factors but not food pouch usage associated with early childhood caries in New Zealand children: Young Foods New Zealand study

Sociodemographic factors but not food pouch usage associated with early childhood caries in New Zealand children: Young Foods New Zealand study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sociodemographic factors but not food pouch usage associated with early childhood caries in New Zealand children: Young Foods New Zealand study Heilok Cheng, Jillian Haszard, Alison Meldrum, Elizabeth Denney-Wilson, and 15 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8704660/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To describe predictors of early childhood caries (ECC, i.e. tooth decay in primary teeth) in toddlers and preschoolers. Design: The Young Foods New Zealand study was a cross-sectional observational study, including a questionnaire for sociodemographic information, oral hygiene practices, and feeding practices, such as food pouch use; measurement of anthropometry; nutrient intake from two 24-hour dietary recalls; and ECC status from dental photographs. Differences between caries-free and caries-positive children were estimated using regression analysis, adjusted for age. Setting: Community study, New Zealand. Participants: 259 children aged 1.0 to 3.9 years. Results: In total, 13.9% of children had ECC. Having ECC was associated with child and carer ethnicity, carer education, childcare use, and current breastfeeding status. Food pouch use, direct feeding from a food pouch nozzle, and weight status were not significantly associated with ECC status. Nutrient intakes were similar in those with and without ECC, including sugars intake. Caries-positive children had lower mean vitamin A (432 vs 526 µg, p=0.004) and marginally lower calcium (634 vs 715 mg, p=0.072) intake, compared to caries-free children, but were at no greater risk of inadequate intake. Conclusions: ECC status was associated with demographic characteristics but not current use of food pouches, in contrast to expectations that pouch use may adversely impact child dental health through exposure to sugary foods. Children with ECC largely met nutritional requirements but had lower vitamin A and calcium intakes. Nutrition & Dietetics Dentistry dietary intake food pouches early childhood caries child health Figures Figure 1 Introduction Feeding and nutrition impact childhood dental health, including tooth formation and the development of health-promoting or cariogenic habits. Well-established dietary factors in dental health include calcium for tooth mineralisation, fluoride in inhibiting de-mineralisation, and free or added sugars that promote cariogenic bacteria activity ( 1 ) . Magnesium, phosphorus, vitamin A, vitamin C, zinc and protein are also important for tooth formation, along with vitamin D for calcium regulation ( 1 – 3 ) . By contrast, deficiencies in protein, energy, and vitamins A, C and D have been linked to impaired tooth development ( 1 – 3 ) . Early childhood caries (ECC) is tooth decay—the presence of one or more decayed, missing or filled tooth surfaces—in the primary teeth of children aged under 6 years ( 4 ) . While dietary exposures have been investigated, most of this research has focused on dietary patterns, food groups or individual foods/drinks (e.g. fruit juice) rather than nutrients, or focused on dental caries in permanent teeth ( 5 , 6 ) . Two studies with 4 year old children found no significant association between ECC and daily energy, total carbohydrate or sucrose intake ( 7 ) , or between micronutrient intake at age 1 year and severe ECC ( 8 ) . Similarly, a study of 3- to 6-year-old preschoolers found no significant association between ECC status and daily energy, macronutrient and micronutrient intake ( 9 ) . However, these studies have been limited by small sample sizes in a low caries prevalence country ( 7 ) , a high proportion of children lost to follow-up ( 8 ) , and single cross-sectional measurements of dietary intake ( 9 ) , and have not addressed new forms of complementary foods consumed by young children. The only study that has investigated associations between new forms of complementary foods (foods added to an infant’s diet when breast milk or infant formula are no longer sufficient to meet nutritional needs) ( 4 ) and risk of ECC was in infants (7–10 months of age) for whom infant milk was their main source of energy, and none of whom had evidence of ECC (unpublished results). Hence, further investigation on associations of complementary feeding method, and nutrient intake, with ECC risk in young children is warranted. The introduction of commercial infant and toddler foods in pouches, with a feeding nozzle that enables direct sucking from the pouch, has prompted concerns about potential impacts on a range of health outcomes. These include delays in oral control for spoon-feeding or finger-feeding; risk of overfeeding easily consumed purées that may lead to excessive weight gain; exposure to high-sugar purées that may lead to ECC; excessive free sugar intake in babies; and repeated exposure to products that may condition children’s taste preferences towards sweet processed foods ( 10 – 12 ) . However, little research has directly examined the impact of commercial infant and toddler food pouches on health outcomes. For this reason, the Young Food New Zealand (YFNZ) cross-sectional study was undertaken to identify the impact of complementary feeding approaches and food pouch use on nutritional and health outcomes in toddlers and young children ( 13 ) . This analysis aimed to describe the early life predictors (demographics, oral hygiene, complementary feeding approach, use of food pouches, nutrient intake, and weight status) of toddlers and preschoolers in the YFNZ study, with and without ECC. Methods As data collection methods for YFNZ have been reported previously ( 14 ) , only methods relevant to the current study will be described. The YFNZ study was an observational cross-sectional study examining nutrition and health in 1- to 3.9-year-old children. Children were recruited by advertisement and word of mouth in three main centres of New Zealand (Dunedin, Auckland and Wellington) between August 2020 and February 2022. The study was approved by [redacted for peer review]. Adult participants provided written informed consent on behalf of their young child before any measures were obtained. The Strengthening the Reporting of Observational Studies in Epidemiology—Nutritional Epidemiology (STROBE-nut) checklist is included as Supplementary File 1. Parents and guardians were eligible to participate if they were 16 years or older; resided in Dunedin, Wellington, or Auckland, in New Zealand; had a child aged 1 to 3.9 years; and had not recently enrolled in a nutrition intervention study that might have influenced their child’s diet. Eligible participants completed two visits, one week apart, with a trained researcher with a nutrition or dietetics background, at their home or university research rooms. The first visit included a main questionnaire, a 24-hour recall of dietary intake, and anthropometric measurements. The second visit included a second 24-hour recall, dental photographs, and a food security questionnaire. During COVID-19 public health lockdowns, the second appointment could be conducted via Zoom teleconference calls, but it was not possible to collect dental photographs. Participants were reimbursed for their time with a $ 100 (NZD) supermarket voucher. The main questionnaire collected demographic information for the respondent and child; eating behaviours, including approach to introduction of solid foods (traditional spoon-feeding or baby-led weaning) and use of food pouches; and child dental health information, such as age of first tooth eruption, oral hygiene methods, and respondent concerns about their child’s teeth. Demographic variables included respondent and child age, sex and ethnicity; and respondent highest level of education, employment status, household food insecurity ( 15 ) , childcare use and area-level socioeconomic deprivation based on postcode and the New Zealand Index of Deprivation ( 16 ) . Ethnicity, reported by the parent or carer, was classified using the Statistics New Zealand prioritisation system, in the following order: Māori, Pacific, Asian, Other, European ( 14 ) . Anthropometry A trained researcher measured child weight and length/height at the first appointment. For children aged under 24 months, weight was measured on infant scales (Seca, Models 224 and 354, Hamburg, Germany) and length was measured on a baby measuring mat (Seca, 210). For children aged 24 months or over, weight was measured on adult scales (Seca, 354) and height was measured using a portable stadiometer (Model WHMH200P, Wedderburn, NZ). All measuring equipment was calibrated weekly. Body mass index (BMI)-for-age z-scores were calculated using the World Health Organization (WHO) Child Growth Standards ( 17 ) . Children were classified into weight categories by BMI z-score, with ‘overweight’ (inclusive of overweight and obesity) defined as BMI z-score > 2; and ‘not overweight’, inclusive of underweight, healthy weight and risk of overweight, defined as BMI z-score ≤ 2. Nutrient intake Face-to-face 24-hour dietary recalls were completed by the primary carer at the first and second appointments. Where possible, diet recalls were administered on different days of the week to capture daily variation in intake. Carers were asked to photograph their child’s foods and beverages (including infant and toddler formula) on the day before the recall, which acted as a memory prompt during the 24-hour recall. The three-pass method was used. The first pass captured a ‘quick-list’, in which the carer listed each food, drink or breastfeed offered in the previous day. The second pass captured additional detail, including a description of each item, product brand name, and preparation method used; the amount offered and consumed, using visual aids such as bottles, dishes and utensils to estimate quantity; and time and place of consumption. In the third pass, the researcher reviewed the recall and probed for forgotten items. Quality checks were undertaken at regular intervals during the study to ensure adherence to data collection protocols. Nutrient intake was determined using FoodWorks 10 software (FoodWorks 10 Professional, v10.0, Xyris Pty Ltd, Brisbane) and the New Zealand FOODfiles 2018 food composition database ( 18 ) . We focused on the association between ECC and known dietary factors contributing to ECC risk or tooth formation (macronutrients, calcium, vitamin A, vitamin C, zinc, and total, free and added sugars). Data are limited for fluoride and iodine in the New Zealand Food Composition Database, and therefore were not included in the analysis: fluoride is only reported for 34 foods ( 18 ) ; and due to low iodine in soil, locally produced food has low iodine levels, although commercially produced bread must be iodine-fortified ( 19 ) . As vitamin D fortification is voluntary in New Zealand, and vitamin D status is better determined by sunlight exposure than dietary measures, vitamin D intake was also not included in the analysis ( 20 ) . Free sugars (sugars added to foods by manufacturers, i.e. sugars naturally present in honey, syrup and fruit juices) and added sugars (sugar, including free sugars, added to foods by manufacturers, but not naturally occurring sugars such as sugar in non-processed fruit, vegetables or milk) were calculated using the FOODfiles database ( 18 ) . However, fruit purée in wet commercial infant and toddler foods was considered to contribute to total sugar, but not added or free sugars – puréed cooked fruits are texture-appropriate for infants, compared to its function as a sweetener in adult diets ( 21 ) . Dental photography Dental photographs were taken at the second appointment. Each set of dental photographs was taken by one researcher, following a pretested protocol and training. Photographic equipment was standardised and comprised an Oppo Reno2 Z mobile phone attached to a Smile Lite Mobile Dental Photography (Smile Line SA, St-Imier, Switzerland) light source ( 22 ) . Photographs were assessed using validated indices for the eruption phase ( 23 ) and dental caries ( 24 ) . Caries-positive participants were contacted to ensure follow up care. Statistical analysis Usual nutrient intake was determined by applying the Multiple Source Method (MSM) to the nutrient intake data from the two 24-hour recalls ( 25 , 26 ) . The proportion of the sample that had inadequate usual intakes (by age and sex group) for protein, calcium, zinc, vitamin A (as retinol equivalents) and vitamin C was determined using the Estimated Average Requirement cut-point method and the Nutrient References Values for Australia and New Zealand ( 27 , 28 ) . Statistical analysis was undertaken in RStudio version 4.2.2 (Posit Software, Boston, MA, USA). The prevalence of ECC was estimated with a 95% confidence interval. Descriptive analysis was reported using means and standard deviations (SD) for continuous data, with median, 25th and 75th percentiles for skewed data. Categorical variables were reported using counts and percentages. Statistical significance defined as p < 0.05. Results Of 290 eligible participants, 260 provided dental photographs – dental photographs for one child were not usable, so the final sample size was 259 (Fig. 1 ). Respondent, child and household characteristics are shown in Table 1 . Respondents—primarily mothers of the participating child (data not shown)—had a mean age of 33.8 years, with more than half being university-educated, of European background, and in part-time or full-time employment. Child age ranged from 12.1 to 47.4 months. Nearly two-thirds of child participants were preschool-aged (24 to 48 months). Most households had two or more children, and most had at least four people in the household. Area-level socioeconomic deprivation reflected the broader New Zealand population ( 29 ) and almost one-third of all households had experienced food insecurity in the past 12 months. Table 1 Demographic characteristics of participants by caries status (n = 259) No caries Caries P-value* n 223 36 Child characteristics Age, mean (SD) months 29.3 (10.5) 36.7 (9.0) < 0.001 Age group, n (%) 0.003 - toddlers (12 to < 24 months) 89 (39.9) 5 (13.9) - preschoolers (24 to < 48 months) 134 (60.1) 31 (86.1) Sex, n (%) 0.520 - male 104 (46.6) 20 (55.6) - female 119 (53.4) 16 (44.4) Ethnicity † , n (%) 0.016 - Māori 53 (23.8) 13 (36.1) - Pacific 35 (15.7) 10 (27.8) - Asian 27 (12.1) 5 (13.9) - Others 4 (1.8) 1 (2.8) - European 104 (46.6) 7 (19.4) Childcare outside the home, n (%) 149 (66.8) 17 (47.2) < 0.001 Respondent characteristics Age ‡ , mean (SD) years 34.0 (5.1) 32.7 (5.5) 0.192 Ethnicity †,‡ , n (%) 0.011 - Māori 38 (17.1) 9 (25.7) - Pacific 28 (12.6) 11 (31.4) - Asian 22 (9.9) 5 (14.3) - Others 5 (2.3) 0 - European 129 (58.1) 10 (28.6) Highest education level ‡ , n (%) 0.021 - School 34 (15.3) 10 (28.6) - Polytechnic or similar 51 (23.0) 11 (31.4) - University 137 (61.7) 14 (40.0) Employment status ‡ , n (%) 0.861 - Full-time 48 (21.7) 8 (22.9) - Part-time 72 (32.6) 10 (28.6) - Other 101 (45.6) 17 (48.6) Household characteristics Number of children in household ‡ , n (%) 0.068 - One 38 (17.2) 3 (8.8) - Two 113 (51.1) 18 (52.9) - Three 44 (19.9) 3 (8.8) - Four or more 26 (11.8) 10 (29.4) Household size ‡ , n (%) 0.131 − 2 to 3 people 39 (17.7) 4 (11.8) − 4 to 5 people 144 (65.2) 19 (55.9) − 6 or more people 38 (17.2) 11 (32.4) Area-level socioeconomic deprivation § , n (%) 0.060 − 1–3 (low) 67 (30.0) 6 (16.7) − 4–7 92 (41.3) 16 (44.4) − 8–10 (high) 64 (28.7) 14 (38.9) Household food insecurity ‡ , n (%) 0.328 - Food secure 140 (65.4) 21 (65.6) - Moderately food insecure 44 (20.6) 4 (12.5) - Severely food insecure 30 (14.0) 7 (21.9) * P-values calculated using a t-test for child age and respondent age, a Fisher’s exact test for age group, and logistic regression adjusted for age for other categorical variables. † Identification with multiple ethnicities was possible with participants prioritised into one group based on the order listed in the table. P-values were calculated without the ‘Others’ ethnicity group included because these sub-groups were too small. ‡ Missing data: respondent age, n = 2; respondent education, n = 2; respondent ethnicity, n = 2; respondent employment, n = 3; number of children in household and household size, n = 4; household food insecurity, n = 13. § Area-level socioeconomic deprivation determined with home address and the New Zealand Deprivation Index 2018 ( 16 ) . The prevalence of ECC (data not shown) was 13.9% (95% CI 9.9–18.7%), with a higher prevalence of caries in those aged 24–48 months (18.8%, 95% CI 13.1–25.6%) compared to 12–24 months (5.3%, 95% CI 1.7–12.0%). Caries-positive children were older than caries-free children (36.7 (9.0) vs. 29.3 (10.5) months, p < 0.001). After adjustment for age, caries-free children were more likely to be of European ethnicity, attend childcare outside the home, and have carers who were of European ethnicity and had a university education (Table 1 ). By contrast, the sex of the child, parental age and employment status and household size did not appear related to the presence of caries. While there was no significant difference in terms of household food insecurity, children with caries tended to live in areas of higher socioeconomic deprivation. Caries-positive and caries-free children had the same median age of first tooth eruption (Table 2 ). Nearly all respondents cleaned their child’s teeth, with no meaningful difference in cleaning by ECC status. Open text responses on dental hygiene practices indicated that nearly all respondents cleaned their child’s teeth with a toothbrush, and over half used toothpaste. Few respondents reported concerns with their child’s dental health, although more respondents had concerns with decay or discolouration for caries-positive children than for caries-free children (11% vs. 5%). Table 2 Oral hygiene practices by caries status (n = 259) No caries Caries P-value* n 223 36 Age of first tooth † , median (25th, 75th percentile) months 6 (5, 8) 6 (5, 8) 0.872 Do you clean your child’s teeth † ? n (%) 0.198 - Yes 205 (92.3) 31 (88.6) - No 1 (0.5) 1 (2.9) - Sometimes 16 (7.2) 3 (8.6) How do you clean their teeth? n (%) ‡ - - Use a toothbrush 215 (96.4) 34 (94.4) - Specified a soft toothbrush 114 (51.1) 19 (52.8) - Specified an electric toothbrush 6 (2.7) 1 (2.8) - Finger brush 3 (1.4) 0 - Wipe with cloth 4 (1.8) 0 - Use toothpaste 126 (56.5) 20 (55.6) - Specified fluoride toothpaste 18 (8.1) 1 (2.8) - Specified age-specific toothpaste 38 (17.0) 7 (19.4) What else do you do to look after your child’s teeth? n (%) ‡ - - Use dental floss 14 (6.3) 5 (13.9) - Use mouthwash 2 (0.9) 1 (2.8) - Visit a dental professional 9 (4.0) 1 (2.8) - Give water after eating 11 (4.9) 3 (8.3) - Avoid sugary foods 7 (3.1) 0 - Avoid sweet drinks 3 (1.4) 2 (5.6) Concerns about child’s dental health, n (%) ‡ - - Medications affecting teeth 2 (0.9) 0 - Decay and/or discolouration 11 (4.9) 4 (11.1) - Difficulty cleaning teeth 8 (3.6) 1 (2.8) * P-values were calculated using a median test for age of first tooth; and logistic regression for child teeth cleaning, adjusted for age. No statistical tests were done for open text responses. † Missing data: age of first tooth n = 3, clean teeth n = 2. ‡ These questions had open text responses so participants might have given multiple responses. Percentages are reported, but not all participants may have responded, so caution is advised when interpreting these. Neither following a baby-led weaning approach at 6 months of age, nor frequency of consuming a baby food pouch in the past month appeared to be related to ECC status (Table 3 ). After adjusting for age, there were no significant differences between caries-positive and caries-free children for the feeding approach used at 6 months of age, the frequency of pouch use, or whether the child sucked the pouch contents directly from the nozzle. While a similar proportion of children were still being breastfed (19% vs. 18%), this difference was statistically significant (p = 0.048) after adjusting for age. In this sample of children aged 12 months or older, those who were still being breastfed had three-fold higher odds of ECC (OR 3.07, 95% CI 1.04–9.10, p = 0.043) after adjusting for age, although numbers were small. Table 3 Feeding characteristics by caries status (n = 259) No caries Caries P-value * n 223 36 Feeding approach at around 6 months of age † , n (%) 0.813 - Traditional spoon feeding 137 (66.8) 25 (69.4) - Partial baby-led weaning 35 (17.1) 4 (11.1) - Baby-led weaning 33 (16.1) 7 (19.4) Frequency of eating ‘ready-to-eat’ food pouches in past month ‡ , n (%) 0.541 - Never 110 (49.6) 23 (63.9) - Infrequently (< 4 times a month) 45 (20.3) 3 (8.3) - Sometimes (1–4 times a week) 41 (18.5) 7 (19.4) - Frequently (5 or more times a week) 26 (11.7) 3 (8.3) For pouch food users, use of nozzle when eating food from a food pouch § , n (%) (n = 124) n = 112 n = 12 0.369 || - Does not use nozzles 17 (15.2) 0 - Uses nozzles 95 (84.8) 12 (100) For food pouch users who use nozzles, frequency of eating food pouches in past month § , n (%) (n = 107) n = 95 n = 12 > 0.999 || - Infrequently or sometimes (≤ 4 times a week) (n = 80) 71 (74.7) 9 (75.0) - Frequently (5 or more times a week) (n = 27) 24 (25.3) 3 (25.0) Still breastfeeding, n (%) 0.043 - Yes 41 (18.4) 7 (19.4) - No 182 (81.6) 29 (80.6) * P-values calculated from logistic regression models adjusted for age. † 17 participants were not having solids at 6 months of age. One participant was missing data for this question. ‡ One participant was missing data for this question. § One participant, with dental caries, who reported eating ‘ready-to-eat’ food pouches in the last month did not respond to this question. || Not testable with logistic regression, so Fisher’s exact test reported. Caries-positive children had a lower mean (SD) vitamin A intake (432 (134) vs. 526 (182) µg, p = 0.004), but there was no significant difference in the prevalence of inadequate vitamin A intake, compared to caries-free children (2.8% vs. 2.7%, respectively; Table 4 ). Caries-positive children had a marginally lower mean calcium intake, although this was not statistically significant after adjusting for age (634 (179) vs. 715 (244) mg, p = 0.072), and there was no significant difference in the prevalence of inadequate calcium intake, compared to caries-free children. There was no significant difference in mean BMI z-score or the proportion who were overweight by ECC status. Table 4 Nutrient intakes *,† , nutrient adequacy and body weight by caries status (n = 259) No caries Caries P-value ‡ n 223 36 Energy intake, mean (SD) kJ 5025 (886) 5307 (694) 0.751 Fat intake, mean (SD) g 45.9 (9.7) 49.4 (8.3) 0.237 Protein intake, mean (SD) g 45.4 (10.3) 49.1 (11.0) 0.481 - Prevalence inadequate protein intake, n (%) 0 0 - Total carbohydrate intake, mean (SD) g 144 (29) 151 (23) 0.760 Total sugars intake, mean (SD) g 67.5 (15.6) 67.9 (11.7) 0.679 Free sugars intake, mean (SD) g 22.5 (12.7) 28.8 (13.5) 0.179 Added sugars intake, mean (SD) g 19.8 (11.3) 25.3 (11.6) 0.182 - Energy intake from total sugars, mean (SD) % 23.0 (4.5) 22.0 (3.9) 0.550 - Energy intake from free sugars, mean (SD) % 7.5 (3.9) 9.2 (3.9) 0.196 - Energy intake from added sugars, mean (SD) % 6.62 (3.5) 8.1 (3.3) 0.205 Calcium intake, mean (SD) mg 715 (244) 634 (179) 0.072 - Prevalence inadequate calcium intake, n (%) 9 (4.0) 0 0.993 Zinc intake, mean (SD) mg 6.1 (1.4) 6.2 (1.3) 0.955 - Prevalence inadequate zinc intake, n (%) 0 0 - Vitamin A intake, mean (SD) µg RE 526 (182) 432 (134) 0.004 - Prevalence inadequate vitamin A intake, n (%) 6 (2.7) 1 (2.8) 0.899 Vitamin C intake § , median (25th, 75th percentile) mg 64.9 (48.6, 87.3) 60.0 (46.2, 81.3) 0.729 - Prevalence inadequate vitamin C intake, n (%) 11 (4.9) 0 0.993 BMI-for-age z-score || , mean (SD) 0.73 (1.08) 0.85 (1.13) 0.432 - Overweight||, n (%) 24 (10.8) 4 (11.1) 0.826 * Nutrient intakes assessed with two 24-h recalls and adjusted to usual intake using the Multiple Source Method (MSM) ( 25 ) . † 1 participant (without caries) was missing dietary data. ‡ P-values for nutrient intakes were calculated using a linear regression model, adjusted for age; P-values for overweight and prevalence of inadequate intakes were calculated using a logistic regression model, adjusted for age. § Skewed distribution, due to 2 participants with supplemental vitamin C use. || BMI-for-age z-score determined using WHO child growth charts (17) . Overweight defined as BMI-for-age z-score > 2. Anthropometric data were missing for 32 participants (30 without caries; 2 with caries). Discussion Our study demonstrated that after adjustment for age, having ECC was associated with child and carer ethnicity, carer education, and childcare use. By contrast, feeding approaches, including whether the child was traditionally spoon-fed or following baby-led weaning early in the complementary feeding period, and current frequency of baby food pouch use, including feeding directly from the nozzle, did not meaningfully differ by ECC status. While breastfeeding after 12 months of age was associated with higher odds of ECC, this analysis was limited by a small sample size (only 7 of 38 caries-positive children were still being breastfed). We also observed that while caries-positive children had a marginally lower dietary calcium intake and significantly lower vitamin A intake, there was no difference in the prevalence of inadequate intakes compared with caries-free children. Although infant and toddler food pouches were introduced as commercial products in 2012 ( 30 ) and considerable concern has been expressed about their use ( 10 – 12 , 31 ) , most published research to date has focused on nutrient content and marketing claims. Few studies have examined actual patterns of use, or association with health outcomes: the First Foods New Zealand study found no significant association between pouch use and iron sufficiency ( 32 ) , or BMI z-score or energy intake in infants ( 33 ) , while analysis of the YFNZ data suggested BMI z-score did not differ in preschoolers who frequently used food pouches compared to non-users, although energy intake was lower ( 14 ) ; and one study found no significant association between BMI z-score and fruit pouch use at 18 months age ( 34 ) . An audit of 276 infant food pouches in Australia found 72.8% of pouches contained free sugars, and fewer than a third of pouches targeted at infants aged 8 months and older were texturally appropriate ( 30 ) . Most food pouches were fruit-based (43%) or dairy-based (32%), and these types of food pouches contained the highest and second-highest average sugar content per 100g across all products. Likewise, an analysis of infant foods in New Zealand identified higher median sugar content in food pouches compared to other non-pouch foods (e.g. cans, jars, bowl/tray meals) ( 35 ) . These types of food pouch may be commonly used with infants and toddlers – 17.4% and 9.6% of infants in the First Foods New Zealand study consumed fruit-based and dairy-based pouches, respectively, across two days of dietary recall ( 21 ) , while 36% and 50% of infants and toddlers in an Australian survey used these types of pouches at least weekly ( 36 ) . An evaluation of 242 infant and toddler food pouches in the United Kingdom, using the WHO Nutrient and Promotion Profile Model, found that an average of 87% of fruit-based (92%) or vegetable-based (63%) purées provided a third of energy as sugar, and that pouches marketed to infants aged 6 months and younger were nutritionally poorer—being more watered-down, less energy-dense, and having more energy from sugar—than those marketed to infants aged 7 months and older ( 37 ) . Notably, no food pouch labels recommended cessation of purées from 12 months of age. These audits found food pouches were a common form of packaging for commercial infant and toddler foods in the United Kingdom (38%), Australia (41%) and New Zealand (64%). This has led to broader public health concerns about pouch foods, including their potential for high exposure to dietary sugar and harmful implications for dental health, particularly if infants suck the food directly through the nozzle. Similarly, using smooth purées for older infants, when they should be developing feeding skills such as picking up food and learning oro-motor control for eating rather than sucking, is not advisable ( 10 ) . Disingenuous marketing language encourages parents to perceive commercial infant and toddler foods as nutritious, even when they contain high levels of free sugar ( 11 , 38 , 39 ) . However, the current study is the first to examine the actual impact of food pouches on dental health. Our results indicate that concerns about food pouches and dental health may not be warranted, at least at the level of food pouch use seen in this population. The only nutrients of potential concern in this analysis were calcium and vitamin A, with caries-positive children having lower intakes. However, their calcium intakes were not more likely to be inadequate than those of caries-free children. While these differences in nutritional intake are not attributable to food pouch use, some pouch foods, such as yoghurt, may contribute to calcium intake. For infants, pouch foods may contribute a fifth of the calcium consumed from complementary foods ( 21 ) , and 50% of infants and 59% of toddlers and preschoolers from one Australian survey consumed dairy-based pouch foods at least weekly ( 36 ) . However, pouch foods may not be an ideal calcium source. An audit of infant pouch foods in Australia found that only 16 of 68 products met calcium daily requirements for infants over 6 months of age ( 30 ) , while an audit of commercial infant and toddler foods in the United States found that calcium nutrient density was lower in yoghurt- or milk-based pouch foods compared to non-pouch foods ( 40 ) . Moreover, dairy pouch foods are higher in total sugars than non-pouch foods ( 35 ) . Therefore, it remains important to meet the calcium requirements for young children through core dairy foods (such as unflavoured milk or yoghurt ( 41 ) ), while balancing the use of sugar-sweetened options (such as flavoured milk, smoothies, milkshakes and flavoured yoghurts) as part of minimising added sugar intake ( 42 ) . While the prevalence of inadequate intakes of vitamin A did not differ by ECC status, mean vitamin A intake was higher for caries-free children compared to caries-positive children in the current study. These findings are consistent with previous research in 3- to 6-year-old preschoolers, which showed that children with fewer than four caries-affected teeth had higher vitamin A intake compared to those with four or more caries-affected teeth. Furthermore, in that study, higher vitamin A intakes were associated with lower odds of ECC severity ( 9 ) . However, another cross-sectional study with 3- to 5-year-old children found no significant association between daily vitamin A intake and either the number of decayed teeth, or caries activity measured in the oral microenvironment ( 43 ) , suggesting that vitamin A intake, as a dietary factor in dental caries risk, may occur independently of a relationship with cariogenic bacteria. While nutritional supplementation with vitamin A and other micronutrients can reduce enamel hypoplasia, which is implicated in tooth formation and risk of ECC ( 44 ) , Mirahmadizadeh et al. found no significant association between the use of vitamin A or D supplements, and the number of decayed teeth or ECC status for children aged 2 to 6 years ( 45 ) . Meeting vitamin A requirements for young children remains important through core foods, such as high-carotenoid fruits and vegetables. Again, while differences in vitamin A intake are not attributable to food pouch use, pouch foods may be considered as a significant contributor to vitamin A, with puréed carrot, sweet potato or pumpkin being common ingredients ( 12 ) . Previous findings demonstrated that pouch foods contributed a median 35% of the vitamin A intake from complementary foods in infants ( 21 ) , although the range of vitamin A content in commercial infant and toddler foods is broad ( 40 ) . More broadly, it has been argued that commercial infant and toddler foods should be subject to regulatory nutritional standards to support health and development ( 37 ) , such as the WHO Nutrient and Promotion Profile Model adapted for Australia and New Zealand ( 46 ) . It must be noted, however, that the small amount of research on the health consequences of pouch use, including the current study, has not yet identified health impacts associated with current patterns of food pouch use. Longer term research in this area is urgently required so that public health messaging can align with a robust evidence base. Demographic characteristics associated with ECC were child and respondent ethnicity, respondent education, and childcare use. After adjustment for age, caries-positive children were less likely to be of European ethnicity, to attend childcare outside the home, and to have carers who were of European ethnicity and had a university education. Furthermore, the number of children in the household and socioeconomic deprivation was marginally associated with ECC. This likely reflects known inequalities and social determinants of health in ECC prevalence in New Zealand and internationally – for example, a carer may experience greater challenges from the responsibilities of caring for more children or socioeconomic deprivation; and persistent, post-colonisation social inequality could limit health service access. Non-attendance of childcare may be linked to financial inaccessibility as a broader social determinant of health, and childcare may also be an avenue for protective factors, such as health education for children and families, and children having regulated meals and snacks ( 47 ) . Prenatal and maternal factors may be linked to ECC risk, such as prenatal calcium and vitamin D intake, which may affect development of tooth enamel in children ( 1 , 5 ) ; and maternal oral health, such as dental caries status, oral hygiene, and oral health knowledge, may impact how mothers approach dental care for children ( 5 , 47 ) . Persistent structural and systemic inequalities affecting Māori and Pacific peoples require systems-level change to reduce inequalities in oral health across the life-course and improve access to care ( 48 ) . Strengths of this study include diverse participation of families in the YFNZ cohort who may be underrepresented in research, including Māori participants and those living in areas of higher deprivation. Anthropometry and dental health checks were conducted by trained researchers, instead of using parental reports. Although only two days of dietary intake were measured, the 24-hour dietary recalls were thorough, used photographic images, and measured uneaten food, and the two days of intake enabled us to calculate usual dietary intake using the Multiple Source Method ( 25 ) . The study also had several limitations, including the lack of data for some nutrients that have been linked to dental health—such as fluoride, iodine and vitamin D—in the New Zealand FOODfiles 2018 food composition database ( 18 ) . In addition, we defined frequent pouch use as consumption of pouches five or more times per week in the past month and did not see an association with ECC status – but it is possible that a different frequency of pouch use would be associated with ECC risk. We chose that frequency of use to reflect approximately daily exposure since the teeth would need to be exposed to food from pouches regularly to experience detrimental impacts. Increased risk might be expected with a higher frequency of consumption, but just 29 (11.2%) of children had consumed pouch foods in the past month, even at that frequency. As an observational study, it is acknowledged that while we have described how predictors of ECC differ by the presence of caries, we have not estimated causal pathways to caries. Finally, whether fruit purées (an ingredient commonly found in pouch foods) should be considered to contribute added or free sugar is controversial. We considered puréed fruit in commercial infant and toddler foods as contributing to total sugar, but not to free or added sugar intake, as puréed fruit is texture-appropriate for infants ( 21 ) , and the YFNZ study included infants as well as toddlers and preschoolers (data not reported here). However, the differences in how sugar contributed by fruit purées is classified can make comparison between studies challenging. For example, an Australian audit—using the Public Health England definition of fruit purée as an added sugar—found that 72.8% of infant food pouches had added sugar ( 30 ) . By contrast, a United Kingdom audit—using the World Health Organization Nutrient and Promotion Profile Model definition, which does not include fruit purée as an added sugar—found only 1% of infant and toddler food pouches had added sugar, despite 58% being high in energy from total sugars ( 37 ) . Regardless of technical definitions, professional health associations advise limiting food pouches to avoid high total sugars intake, not just free or added sugars intake, and associated health concerns ( 10 – 12 ) . Conclusion The presence of caries in early childhood differed by child and carer ethnicity, carer education, and childcare use. Caries-positive children had lower vitamin A intake and marginally lower calcium intake than caries-free children, but were at no greater risk of inadequate intake. Feeding behaviours, including the current frequency of baby food pouch use, were not predictors of ECC. Product audits have highlighted the increasing presence and availability of pouch foods, and as such, further empirical research that examines the long term impact on dental health of frequent food pouch use, including pouch type by food group, is required. 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Int J Paediatr Dent 22:157–168. 10.1111/j.1365-263X.2011.01186.x Kanagaratnam S, Schluter PJ (2019) A review of early childhood caries, risk factors and preventive strategies. N Z Dent J 115:133–150 Additional Declarations The authors declare no competing interests. Supplementary Files SupplementaryFile1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Participant flow chart.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8704660/v1/079a88d2cd20e4caa221801e.png"},{"id":101751831,"identity":"e8af4a49-e973-4736-ab14-f969b0863b04","added_by":"auto","created_at":"2026-02-03 10:23:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1003395,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8704660/v1/19e37f43-cc78-44fc-a134-456567373079.pdf"},{"id":101436953,"identity":"57f390ef-80ad-415d-9c25-36bab16fc96c","added_by":"auto","created_at":"2026-01-29 16:26:53","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":31102,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8704660/v1/fedc2b53976e8d011c7c9a29.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eSociodemographic factors but not food pouch usage associated with early childhood caries in New Zealand children: Young Foods New Zealand study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFeeding and nutrition impact childhood dental health, including tooth formation and the development of health-promoting or cariogenic habits. Well-established dietary factors in dental health include calcium for tooth mineralisation, fluoride in inhibiting de-mineralisation, and free or added sugars that promote cariogenic bacteria activity\u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e. Magnesium, phosphorus, vitamin A, vitamin C, zinc and protein are also important for tooth formation, along with vitamin D for calcium regulation\u003csup\u003e(\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e. By contrast, deficiencies in protein, energy, and vitamins A, C and D have been linked to impaired tooth development\u003csup\u003e(\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e. Early childhood caries (ECC) is tooth decay\u0026mdash;the presence of one or more decayed, missing or filled tooth surfaces\u0026mdash;in the primary teeth of children aged under 6 years\u003csup\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e. While dietary exposures have been investigated, most of this research has focused on dietary patterns, food groups or individual foods/drinks (e.g. fruit juice) rather than nutrients, or focused on dental caries in permanent teeth\u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/sup\u003e. Two studies with 4 year old children found no significant association between ECC and daily energy, total carbohydrate or sucrose intake\u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e, or between micronutrient intake at age 1 year and severe ECC\u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e. Similarly, a study of 3- to 6-year-old preschoolers found no significant association between ECC status and daily energy, macronutrient and micronutrient intake\u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e. However, these studies have been limited by small sample sizes in a low caries prevalence country\u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e, a high proportion of children lost to follow-up\u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e, and single cross-sectional measurements of dietary intake\u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e, and have not addressed new forms of complementary foods consumed by young children. The only study that has investigated associations between new forms of complementary foods (foods added to an infant\u0026rsquo;s diet when breast milk or infant formula are no longer sufficient to meet nutritional needs)\u003csup\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e and risk of ECC was in infants (7\u0026ndash;10 months of age) for whom infant milk was their main source of energy, and none of whom had evidence of ECC (unpublished results). Hence, further investigation on associations of complementary feeding method, and nutrient intake, with ECC risk in young children is warranted.\u003c/p\u003e \u003cp\u003eThe introduction of commercial infant and toddler foods in pouches, with a feeding nozzle that enables direct sucking from the pouch, has prompted concerns about potential impacts on a range of health outcomes. These include delays in oral control for spoon-feeding or finger-feeding; risk of overfeeding easily consumed pur\u0026eacute;es that may lead to excessive weight gain; exposure to high-sugar pur\u0026eacute;es that may lead to ECC; excessive free sugar intake in babies; and repeated exposure to products that may condition children\u0026rsquo;s taste preferences towards sweet processed foods\u003csup\u003e(\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e. However, little research has directly examined the impact of commercial infant and toddler food pouches on health outcomes. For this reason, the Young Food New Zealand (YFNZ) cross-sectional study was undertaken to identify the impact of complementary feeding approaches and food pouch use on nutritional and health outcomes in toddlers and young children\u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis analysis aimed to describe the early life predictors (demographics, oral hygiene, complementary feeding approach, use of food pouches, nutrient intake, and weight status) of toddlers and preschoolers in the YFNZ study, with and without ECC.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eAs data collection methods for YFNZ have been reported previously\u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e, only methods relevant to the current study will be described. The YFNZ study was an observational cross-sectional study examining nutrition and health in 1- to 3.9-year-old children. Children were recruited by advertisement and word of mouth in three main centres of New Zealand (Dunedin, Auckland and Wellington) between August 2020 and February 2022. The study was approved by [redacted for peer review]. Adult participants provided written informed consent on behalf of their young child before any measures were obtained. The Strengthening the Reporting of Observational Studies in Epidemiology\u0026mdash;Nutritional Epidemiology (STROBE-nut) checklist is included as Supplementary File 1.\u003c/p\u003e \u003cp\u003e Parents and guardians were eligible to participate if they were 16 years or older; resided in Dunedin, Wellington, or Auckland, in New Zealand; had a child aged 1 to 3.9 years; and had not recently enrolled in a nutrition intervention study that might have influenced their child\u0026rsquo;s diet. Eligible participants completed two visits, one week apart, with a trained researcher with a nutrition or dietetics background, at their home or university research rooms. The first visit included a main questionnaire, a 24-hour recall of dietary intake, and anthropometric measurements. The second visit included a second 24-hour recall, dental photographs, and a food security questionnaire. During COVID-19 public health lockdowns, the second appointment could be conducted via Zoom teleconference calls, but it was not possible to collect dental photographs. Participants were reimbursed for their time with a \u003cspan\u003e$\u003c/span\u003e100 (NZD) supermarket voucher.\u003c/p\u003e \u003cp\u003eThe main questionnaire collected demographic information for the respondent and child; eating behaviours, including approach to introduction of solid foods (traditional spoon-feeding or baby-led weaning) and use of food pouches; and child dental health information, such as age of first tooth eruption, oral hygiene methods, and respondent concerns about their child\u0026rsquo;s teeth. Demographic variables included respondent and child age, sex and ethnicity; and respondent highest level of education, employment status, household food insecurity\u003csup\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/sup\u003e, childcare use and area-level socioeconomic deprivation based on postcode and the New Zealand Index of Deprivation\u003csup\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/sup\u003e. Ethnicity, reported by the parent or carer, was classified using the Statistics New Zealand prioritisation system, in the following order: Māori, Pacific, Asian, Other, European\u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAnthropometry\u003c/h2\u003e \u003cp\u003eA trained researcher measured child weight and length/height at the first appointment. For children aged under 24 months, weight was measured on infant scales (Seca, Models 224 and 354, Hamburg, Germany) and length was measured on a baby measuring mat (Seca, 210). For children aged 24 months or over, weight was measured on adult scales (Seca, 354) and height was measured using a portable stadiometer (Model WHMH200P, Wedderburn, NZ). All measuring equipment was calibrated weekly. Body mass index (BMI)-for-age z-scores were calculated using the World Health Organization (WHO) Child Growth Standards\u003csup\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eChildren were classified into weight categories by BMI z-score, with \u0026lsquo;overweight\u0026rsquo; (inclusive of overweight and obesity) defined as BMI z-score\u0026thinsp;\u0026gt;\u0026thinsp;2; and \u0026lsquo;not overweight\u0026rsquo;, inclusive of underweight, healthy weight and risk of overweight, defined as BMI z-score\u0026thinsp;\u0026le;\u0026thinsp;2.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eNutrient intake\u003c/h3\u003e\n\u003cp\u003eFace-to-face 24-hour dietary recalls were completed by the primary carer at the first and second appointments. Where possible, diet recalls were administered on different days of the week to capture daily variation in intake. Carers were asked to photograph their child\u0026rsquo;s foods and beverages (including infant and toddler formula) on the day before the recall, which acted as a memory prompt during the 24-hour recall. The three-pass method was used. The first pass captured a \u0026lsquo;quick-list\u0026rsquo;, in which the carer listed each food, drink or breastfeed offered in the previous day. The second pass captured additional detail, including a description of each item, product brand name, and preparation method used; the amount offered and consumed, using visual aids such as bottles, dishes and utensils to estimate quantity; and time and place of consumption. In the third pass, the researcher reviewed the recall and probed for forgotten items. Quality checks were undertaken at regular intervals during the study to ensure adherence to data collection protocols.\u003c/p\u003e \u003cp\u003eNutrient intake was determined using FoodWorks 10 software (FoodWorks 10 Professional, v10.0, Xyris Pty Ltd, Brisbane) and the New Zealand FOODfiles 2018 food composition database\u003csup\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e. We focused on the association between ECC and known dietary factors contributing to ECC risk or tooth formation (macronutrients, calcium, vitamin A, vitamin C, zinc, and total, free and added sugars). Data are limited for fluoride and iodine in the New Zealand Food Composition Database, and therefore were not included in the analysis: fluoride is only reported for 34 foods\u003csup\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e; and due to low iodine in soil, locally produced food has low iodine levels, although commercially produced bread must be iodine-fortified\u003csup\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/sup\u003e. As vitamin D fortification is voluntary in New Zealand, and vitamin D status is better determined by sunlight exposure than dietary measures, vitamin D intake was also not included in the analysis\u003csup\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/sup\u003e. Free sugars (sugars added to foods by manufacturers, i.e. sugars naturally present in honey, syrup and fruit juices) and added sugars (sugar, including free sugars, added to foods by manufacturers, but not naturally occurring sugars such as sugar in non-processed fruit, vegetables or milk) were calculated using the FOODfiles database\u003csup\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e. However, fruit pur\u0026eacute;e in wet commercial infant and toddler foods was considered to contribute to total sugar, but not added or free sugars \u0026ndash; pur\u0026eacute;ed cooked fruits are texture-appropriate for infants, compared to its function as a sweetener in adult diets\u003csup\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eDental photography\u003c/h3\u003e\n\u003cp\u003eDental photographs were taken at the second appointment. Each set of dental photographs was taken by one researcher, following a pretested protocol and training. Photographic equipment was standardised and comprised an Oppo Reno2 Z mobile phone attached to a Smile Lite Mobile Dental Photography (Smile Line SA, St-Imier, Switzerland) light source\u003csup\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/sup\u003e. Photographs were assessed using validated indices for the eruption phase\u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/sup\u003e and dental caries\u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e. Caries-positive participants were contacted to ensure follow up care.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eUsual nutrient intake was determined by applying the Multiple Source Method (MSM) to the nutrient intake data from the two 24-hour recalls\u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/sup\u003e. The proportion of the sample that had inadequate usual intakes (by age and sex group) for protein, calcium, zinc, vitamin A (as retinol equivalents) and vitamin C was determined using the Estimated Average Requirement cut-point method and the Nutrient References Values for Australia and New Zealand \u003csup\u003e(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eStatistical analysis was undertaken in RStudio version 4.2.2 (Posit Software, Boston, MA, USA). The prevalence of ECC was estimated with a 95% confidence interval. Descriptive analysis was reported using means and standard deviations (SD) for continuous data, with median, 25th and 75th percentiles for skewed data. Categorical variables were reported using counts and percentages. Statistical significance defined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf 290 eligible participants, 260 provided dental photographs \u0026ndash; dental photographs for one child were not usable, so the final sample size was 259 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRespondent, child and household characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Respondents\u0026mdash;primarily mothers of the participating child (data not shown)\u0026mdash;had a mean age of 33.8 years, with more than half being university-educated, of European background, and in part-time or full-time employment. Child age ranged from 12.1 to 47.4 months. Nearly two-thirds of child participants were preschool-aged (24 to 48 months). Most households had two or more children, and most had at least four people in the household. Area-level socioeconomic deprivation reflected the broader New Zealand population\u003csup\u003e(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/sup\u003e and almost one-third of all households had experienced food insecurity in the past 12 months.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of participants by caries status (n\u0026thinsp;=\u0026thinsp;259)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo caries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eCaries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean (SD) months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- toddlers (12 to \u0026lt;\u0026thinsp;24 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e89 (39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- preschoolers (24 to \u0026lt;\u0026thinsp;48 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e134 (60.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e31 (86.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.520\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e104 (46.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e20 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e119 (53.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e16 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnicity\u003csup\u003e\u0026dagger;\u003c/sup\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Māori\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e53 (23.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e13 (36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Pacific\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e35 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Asian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e27 (12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- European\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e104 (46.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChildcare outside the home, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e149 (66.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e17 (47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespondent characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003csup\u003e\u0026Dagger;\u003c/sup\u003e, mean (SD) years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnicity\u003csup\u003e\u0026dagger;,\u0026Dagger;\u003c/sup\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Māori\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e38 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e9 (25.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Pacific\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e28 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e11 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Asian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e22 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e5 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- European\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e129 (58.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest education level\u003csup\u003e\u0026Dagger;\u003c/sup\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e34 (15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Polytechnic or similar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e51 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e11 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e137 (61.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment status\u003csup\u003e\u0026Dagger;\u003c/sup\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.861\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Full-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e48 (21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e8 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Part-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e72 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e101 (45.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e17 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHousehold characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of children in household\u003csup\u003e\u0026Dagger;\u003c/sup\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- One\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e38 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Two\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e113 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e18 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Three\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e44 (19.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Four or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e26 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10 (29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold size\u003csup\u003e\u0026Dagger;\u003c/sup\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;2 to 3 people\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e39 (17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;4 to 5 people\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e144 (65.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e19 (55.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;6 or more people\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e38 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e11 (32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArea-level socioeconomic deprivation\u003csup\u003e\u0026sect;\u003c/sup\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;1\u0026ndash;3 (low)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e67 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;4\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e92 (41.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e16 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;8\u0026ndash;10 (high)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e64 (28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14 (38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold food insecurity\u003csup\u003e\u0026Dagger;\u003c/sup\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.328\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Food secure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e140 (65.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e21 (65.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Moderately food insecure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e44 (20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Severely food insecure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e30 (14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e*\u003c/sup\u003e P-values calculated using a t-test for child age and respondent age, a Fisher\u0026rsquo;s exact test for age group, and logistic regression adjusted for age for other categorical variables.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e Identification with multiple ethnicities was possible with participants prioritised into one group based on the order listed in the table. P-values were calculated without the \u0026lsquo;Others\u0026rsquo; ethnicity group included because these sub-groups were too small.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e Missing data: respondent age, n\u0026thinsp;=\u0026thinsp;2; respondent education, n\u0026thinsp;=\u0026thinsp;2; respondent ethnicity, n\u0026thinsp;=\u0026thinsp;2; respondent employment, n\u0026thinsp;=\u0026thinsp;3; number of children in household and household size, n\u0026thinsp;=\u0026thinsp;4; household food insecurity, n\u0026thinsp;=\u0026thinsp;13.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u0026sect;\u003c/sup\u003e Area-level socioeconomic deprivation determined with home address and the New Zealand Deprivation Index 2018\u003csup\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/sup\u003e.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe prevalence of ECC (data not shown) was 13.9% (95% CI 9.9\u0026ndash;18.7%), with a higher prevalence of caries in those aged 24\u0026ndash;48 months (18.8%, 95% CI 13.1\u0026ndash;25.6%) compared to 12\u0026ndash;24 months (5.3%, 95% CI 1.7\u0026ndash;12.0%). Caries-positive children were older than caries-free children (36.7 (9.0) vs. 29.3 (10.5) months, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). After adjustment for age, caries-free children were more likely to be of European ethnicity, attend childcare outside the home, and have carers who were of European ethnicity and had a university education (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). By contrast, the sex of the child, parental age and employment status and household size did not appear related to the presence of caries. While there was no significant difference in terms of household food insecurity, children with caries tended to live in areas of higher socioeconomic deprivation.\u003c/p\u003e \u003cp\u003eCaries-positive and caries-free children had the same median age of first tooth eruption (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Nearly all respondents cleaned their child\u0026rsquo;s teeth, with no meaningful difference in cleaning by ECC status. Open text responses on dental hygiene practices indicated that nearly all respondents cleaned their child\u0026rsquo;s teeth with a toothbrush, and over half used toothpaste. Few respondents reported concerns with their child\u0026rsquo;s dental health, although more respondents had concerns with decay or discolouration for caries-positive children than for caries-free children (11% vs. 5%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOral hygiene practices by caries status (n\u0026thinsp;=\u0026thinsp;259)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo caries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eCaries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of first tooth\u003csup\u003e\u0026dagger;\u003c/sup\u003e, median (25th, 75th percentile) months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5, 8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(5, 8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.872\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you clean your child\u0026rsquo;s teeth\u003csup\u003e\u0026dagger;\u003c/sup\u003e? n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e205 (92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e31 (88.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Sometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e16 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow do you clean their teeth? n (%)\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Use a toothbrush\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e215 (96.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e34 (94.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Specified a soft toothbrush\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e114 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e19 (52.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Specified an electric toothbrush\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e6 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Finger brush\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Wipe with cloth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Use toothpaste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e126 (56.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e20 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Specified fluoride toothpaste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e18 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Specified age-specific toothpaste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e38 (17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat else do you do to look after your child\u0026rsquo;s teeth? n (%)\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Use dental floss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e14 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Use mouthwash\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Visit a dental professional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e9 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Give water after eating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e11 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Avoid sugary foods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Avoid sweet drinks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcerns about child\u0026rsquo;s dental health, n (%)\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Medications affecting teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Decay and/or discolouration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e11 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Difficulty cleaning teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e8 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e*\u003c/sup\u003e P-values were calculated using a median test for age of first tooth; and logistic regression for child teeth cleaning, adjusted for age. No statistical tests were done for open text responses.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e Missing data: age of first tooth n\u0026thinsp;=\u0026thinsp;3, clean teeth n\u0026thinsp;=\u0026thinsp;2.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e These questions had open text responses so participants might have given multiple responses. Percentages are reported, but not all participants may have responded, so caution is advised when interpreting these.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNeither following a baby-led weaning approach at 6 months of age, nor frequency of consuming a baby food pouch in the past month appeared to be related to ECC status (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). After adjusting for age, there were no significant differences between caries-positive and caries-free children for the feeding approach used at 6 months of age, the frequency of pouch use, or whether the child sucked the pouch contents directly from the nozzle. While a similar proportion of children were still being breastfed (19% vs. 18%), this difference was statistically significant (p\u0026thinsp;=\u0026thinsp;0.048) after adjusting for age. In this sample of children aged 12 months or older, those who were still being breastfed had three-fold higher odds of ECC (OR 3.07, 95% CI 1.04\u0026ndash;9.10, p\u0026thinsp;=\u0026thinsp;0.043) after adjusting for age, although numbers were small.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFeeding characteristics by caries status (n\u0026thinsp;=\u0026thinsp;259)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo caries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCaries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeeding approach at around 6 months of age\u003csup\u003e\u0026dagger;\u003c/sup\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.813\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Traditional spoon feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137 (66.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (69.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Partial baby-led weaning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Baby-led weaning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of eating \u0026lsquo;ready-to-eat\u0026rsquo; food pouches in past month\u003csup\u003e\u0026Dagger;\u003c/sup\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.541\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Never\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110 (49.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (63.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Infrequently (\u0026lt;\u0026thinsp;4 times a month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Sometimes (1\u0026ndash;4 times a week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Frequently (5 or more times a week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFor pouch food users, use of nozzle when eating food from a food pouch\u003csup\u003e\u0026sect;\u003c/sup\u003e, n (%) (n\u0026thinsp;=\u0026thinsp;124)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.369\u003csup\u003e||\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Does not use nozzles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Uses nozzles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95 (84.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFor food pouch users who use nozzles, frequency of eating food pouches in past month\u003csup\u003e\u0026sect;\u003c/sup\u003e, n (%) (n\u0026thinsp;=\u0026thinsp;107)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003csup\u003e||\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Infrequently or sometimes (\u0026le;\u0026thinsp;4 times a week) (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (74.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Frequently (5 or more times a week) (n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (25.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStill breastfeeding, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e182 (81.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (80.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e*\u003c/sup\u003e P-values calculated from logistic regression models adjusted for age.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e 17 participants were not having solids at 6 months of age. One participant was missing data for this question.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e One participant was missing data for this question.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u0026sect;\u003c/sup\u003e One participant, with dental caries, who reported eating \u0026lsquo;ready-to-eat\u0026rsquo; food pouches in the last month did not respond to this question.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e||\u003c/sup\u003e Not testable with logistic regression, so Fisher\u0026rsquo;s exact test reported.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCaries-positive children had a lower mean (SD) vitamin A intake (432 (134) vs. 526 (182) \u0026micro;g, p\u0026thinsp;=\u0026thinsp;0.004), but there was no significant difference in the prevalence of inadequate vitamin A intake, compared to caries-free children (2.8% vs. 2.7%, respectively; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Caries-positive children had a marginally lower mean calcium intake, although this was not statistically significant after adjusting for age (634 (179) vs. 715 (244) mg, p\u0026thinsp;=\u0026thinsp;0.072), and there was no significant difference in the prevalence of inadequate calcium intake, compared to caries-free children. There was no significant difference in mean BMI z-score or the proportion who were overweight by ECC status.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNutrient intakes\u003csup\u003e*,\u0026dagger;\u003c/sup\u003e, nutrient adequacy and body weight by caries status (n\u0026thinsp;=\u0026thinsp;259)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNo caries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eCaries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnergy intake, mean (SD) kJ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(886)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(694)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.751\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFat intake, mean (SD) g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtein intake, mean (SD) g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Prevalence inadequate protein intake, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal carbohydrate intake, mean (SD) g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.760\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal sugars intake, mean (SD) g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFree sugars intake, mean (SD) g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdded sugars intake, mean (SD) g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Energy intake from total sugars, mean (SD) %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.550\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Energy intake from free sugars, mean (SD) %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Energy intake from added sugars, mean (SD) %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium intake, mean (SD) mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(244)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(179)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Prevalence inadequate calcium intake, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e9 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZinc intake, mean (SD) mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.955\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Prevalence inadequate zinc intake, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVitamin A intake, mean (SD) \u0026micro;g RE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(182)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(134)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Prevalence inadequate vitamin A intake, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e6 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.899\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVitamin C intake\u003csup\u003e\u0026sect;\u003c/sup\u003e, median (25th, 75th percentile) mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(48.6, 87.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(46.2, 81.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.729\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Prevalence inadequate vitamin C intake, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e11 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI-for-age z-score\u003csup\u003e||\u003c/sup\u003e, mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(1.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Overweight||, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e24 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.826\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e*\u003c/sup\u003e Nutrient intakes assessed with two 24-h recalls and adjusted to usual intake using the Multiple Source Method (MSM)\u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/sup\u003e.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e 1 participant (without caries) was missing dietary data.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e P-values for nutrient intakes were calculated using a linear regression model, adjusted for age; P-values for overweight and prevalence of inadequate intakes were calculated using a logistic regression model, adjusted for age.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u0026sect;\u003c/sup\u003e Skewed distribution, due to 2 participants with supplemental vitamin C use.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e||\u003c/sup\u003e BMI-for-age z-score determined using WHO child growth charts\u003csup\u003e(17)\u003c/sup\u003e. Overweight defined as BMI-for-age z-score\u0026thinsp;\u0026gt;\u0026thinsp;2. Anthropometric data were missing for 32 participants (30 without caries; 2 with caries).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e Our study demonstrated that after adjustment for age, having ECC was associated with child and carer ethnicity, carer education, and childcare use. By contrast, feeding approaches, including whether the child was traditionally spoon-fed or following baby-led weaning early in the complementary feeding period, and current frequency of baby food pouch use, including feeding directly from the nozzle, did not meaningfully differ by ECC status. While breastfeeding after 12 months of age was associated with higher odds of ECC, this analysis was limited by a small sample size (only 7 of 38 caries-positive children were still being breastfed). We also observed that while caries-positive children had a marginally lower dietary calcium intake and significantly lower vitamin A intake, there was no difference in the prevalence of inadequate intakes compared with caries-free children.\u003c/p\u003e \u003cp\u003eAlthough infant and toddler food pouches were introduced as commercial products in 2012\u003csup\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/sup\u003e and considerable concern has been expressed about their use\u003csup\u003e(\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/sup\u003e, most published research to date has focused on nutrient content and marketing claims. Few studies have examined actual patterns of use, or association with health outcomes: the First Foods New Zealand study found no significant association between pouch use and iron sufficiency\u003csup\u003e(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/sup\u003e, or BMI z-score or energy intake in infants\u003csup\u003e(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/sup\u003e, while analysis of the YFNZ data suggested BMI z-score did not differ in preschoolers who frequently used food pouches compared to non-users, although energy intake was lower\u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e; and one study found no significant association between BMI z-score and fruit pouch use at 18 months age\u003csup\u003e(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/sup\u003e. An audit of 276 infant food pouches in Australia found 72.8% of pouches contained free sugars, and fewer than a third of pouches targeted at infants aged 8 months and older were texturally appropriate\u003csup\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/sup\u003e. Most food pouches were fruit-based (43%) or dairy-based (32%), and these types of food pouches contained the highest and second-highest average sugar content per 100g across all products. Likewise, an analysis of infant foods in New Zealand identified higher median sugar content in food pouches compared to other non-pouch foods (e.g. cans, jars, bowl/tray meals)\u003csup\u003e(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/sup\u003e. These types of food pouch may be commonly used with infants and toddlers \u0026ndash; 17.4% and 9.6% of infants in the First Foods New Zealand study consumed fruit-based and dairy-based pouches, respectively, across two days of dietary recall\u003csup\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e, while 36% and 50% of infants and toddlers in an Australian survey used these types of pouches at least weekly\u003csup\u003e(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/sup\u003e. An evaluation of 242 infant and toddler food pouches in the United Kingdom, using the WHO Nutrient and Promotion Profile Model, found that an average of 87% of fruit-based (92%) or vegetable-based (63%) pur\u0026eacute;es provided a third of energy as sugar, and that pouches marketed to infants aged 6 months and younger were nutritionally poorer\u0026mdash;being more watered-down, less energy-dense, and having more energy from sugar\u0026mdash;than those marketed to infants aged 7 months and older\u003csup\u003e(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)\u003c/sup\u003e. Notably, no food pouch labels recommended cessation of pur\u0026eacute;es from 12 months of age. These audits found food pouches were a common form of packaging for commercial infant and toddler foods in the United Kingdom (38%), Australia (41%) and New Zealand (64%). This has led to broader public health concerns about pouch foods, including their potential for high exposure to dietary sugar and harmful implications for dental health, particularly if infants suck the food directly through the nozzle. Similarly, using smooth pur\u0026eacute;es for older infants, when they should be developing feeding skills such as picking up food and learning oro-motor control for eating rather than sucking, is not advisable\u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e. Disingenuous marketing language encourages parents to perceive commercial infant and toddler foods as nutritious, even when they contain high levels of free sugar\u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)\u003c/sup\u003e. However, the current study is the first to examine the actual impact of food pouches on dental health. Our results indicate that concerns about food pouches and dental health may not be warranted, at least at the level of food pouch use seen in this population.\u003c/p\u003e \u003cp\u003eThe only nutrients of potential concern in this analysis were calcium and vitamin A, with caries-positive children having lower intakes. However, their calcium intakes were not more likely to be inadequate than those of caries-free children. While these differences in nutritional intake are not attributable to food pouch use, some pouch foods, such as yoghurt, may contribute to calcium intake. For infants, pouch foods may contribute a fifth of the calcium consumed from complementary foods\u003csup\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e, and 50% of infants and 59% of toddlers and preschoolers from one Australian survey consumed dairy-based pouch foods at least weekly\u003csup\u003e(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/sup\u003e. However, pouch foods may not be an ideal calcium source. An audit of infant pouch foods in Australia found that only 16 of 68 products met calcium daily requirements for infants over 6 months of age\u003csup\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/sup\u003e, while an audit of commercial infant and toddler foods in the United States found that calcium nutrient density was lower in yoghurt- or milk-based pouch foods compared to non-pouch foods\u003csup\u003e(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e)\u003c/sup\u003e. Moreover, dairy pouch foods are higher in total sugars than non-pouch foods\u003csup\u003e(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/sup\u003e. Therefore, it remains important to meet the calcium requirements for young children through core dairy foods (such as unflavoured milk or yoghurt\u003csup\u003e(\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e)\u003c/sup\u003e), while balancing the use of sugar-sweetened options (such as flavoured milk, smoothies, milkshakes and flavoured yoghurts) as part of minimising added sugar intake\u003csup\u003e(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWhile the prevalence of inadequate intakes of vitamin A did not differ by ECC status, mean vitamin A intake was higher for caries-free children compared to caries-positive children in the current study. These findings are consistent with previous research in 3- to 6-year-old preschoolers, which showed that children with fewer than four caries-affected teeth had higher vitamin A intake compared to those with four or more caries-affected teeth. Furthermore, in that study, higher vitamin A intakes were associated with lower odds of ECC severity\u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e. However, another cross-sectional study with 3- to 5-year-old children found no significant association between daily vitamin A intake and either the number of decayed teeth, or caries activity measured in the oral microenvironment\u003csup\u003e(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e)\u003c/sup\u003e, suggesting that vitamin A intake, as a dietary factor in dental caries risk, may occur independently of a relationship with cariogenic bacteria. While nutritional supplementation with vitamin A and other micronutrients can reduce enamel hypoplasia, which is implicated in tooth formation and risk of ECC\u003csup\u003e(\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e)\u003c/sup\u003e, Mirahmadizadeh et al. found no significant association between the use of vitamin A or D supplements, and the number of decayed teeth or ECC status for children aged 2 to 6 years\u003csup\u003e(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMeeting vitamin A requirements for young children remains important through core foods, such as high-carotenoid fruits and vegetables. Again, while differences in vitamin A intake are not attributable to food pouch use, pouch foods may be considered as a significant contributor to vitamin A, with pur\u0026eacute;ed carrot, sweet potato or pumpkin being common ingredients\u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e. Previous findings demonstrated that pouch foods contributed a median 35% of the vitamin A intake from complementary foods in infants\u003csup\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e, although the range of vitamin A content in commercial infant and toddler foods is broad\u003csup\u003e(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e)\u003c/sup\u003e. More broadly, it has been argued that commercial infant and toddler foods should be subject to regulatory nutritional standards to support health and development\u003csup\u003e(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)\u003c/sup\u003e, such as the WHO Nutrient and Promotion Profile Model adapted for Australia and New Zealand\u003csup\u003e(\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e)\u003c/sup\u003e. It must be noted, however, that the small amount of research on the health consequences of pouch use, including the current study, has not yet identified health impacts associated with current patterns of food pouch use. Longer term research in this area is urgently required so that public health messaging can align with a robust evidence base.\u003c/p\u003e \u003cp\u003eDemographic characteristics associated with ECC were child and respondent ethnicity, respondent education, and childcare use. After adjustment for age, caries-positive children were less likely to be of European ethnicity, to attend childcare outside the home, and to have carers who were of European ethnicity and had a university education. Furthermore, the number of children in the household and socioeconomic deprivation was marginally associated with ECC. This likely reflects known inequalities and social determinants of health in ECC prevalence in New Zealand and internationally \u0026ndash; for example, a carer may experience greater challenges from the responsibilities of caring for more children or socioeconomic deprivation; and persistent, post-colonisation social inequality could limit health service access. Non-attendance of childcare may be linked to financial inaccessibility as a broader social determinant of health, and childcare may also be an avenue for protective factors, such as health education for children and families, and children having regulated meals and snacks\u003csup\u003e(\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e)\u003c/sup\u003e. Prenatal and maternal factors may be linked to ECC risk, such as prenatal calcium and vitamin D intake, which may affect development of tooth enamel in children\u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e; and maternal oral health, such as dental caries status, oral hygiene, and oral health knowledge, may impact how mothers approach dental care for children\u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e)\u003c/sup\u003e. Persistent structural and systemic inequalities affecting Māori and Pacific peoples require systems-level change to reduce inequalities in oral health across the life-course and improve access to care\u003csup\u003e(\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eStrengths of this study include diverse participation of families in the YFNZ cohort who may be underrepresented in research, including Māori participants and those living in areas of higher deprivation. Anthropometry and dental health checks were conducted by trained researchers, instead of using parental reports. Although only two days of dietary intake were measured, the 24-hour dietary recalls were thorough, used photographic images, and measured uneaten food, and the two days of intake enabled us to calculate usual dietary intake using the Multiple Source Method\u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/sup\u003e. The study also had several limitations, including the lack of data for some nutrients that have been linked to dental health\u0026mdash;such as fluoride, iodine and vitamin D\u0026mdash;in the New Zealand FOODfiles 2018 food composition database\u003csup\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e. In addition, we defined frequent pouch use as consumption of pouches five or more times per week in the past month and did not see an association with ECC status \u0026ndash; but it is possible that a different frequency of pouch use would be associated with ECC risk. We chose that frequency of use to reflect approximately daily exposure since the teeth would need to be exposed to food from pouches regularly to experience detrimental impacts. Increased risk might be expected with a higher frequency of consumption, but just 29 (11.2%) of children had consumed pouch foods in the past month, even at that frequency. As an observational study, it is acknowledged that while we have described how predictors of ECC differ by the presence of caries, we have not estimated causal pathways to caries. Finally, whether fruit pur\u0026eacute;es (an ingredient commonly found in pouch foods) should be considered to contribute added or free sugar is controversial. We considered pur\u0026eacute;ed fruit in commercial infant and toddler foods as contributing to total sugar, but not to free or added sugar intake, as pur\u0026eacute;ed fruit is texture-appropriate for infants\u003csup\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e, and the YFNZ study included infants as well as toddlers and preschoolers (data not reported here). However, the differences in how sugar contributed by fruit pur\u0026eacute;es is classified can make comparison between studies challenging. For example, an Australian audit\u0026mdash;using the Public Health England definition of fruit pur\u0026eacute;e as an added sugar\u0026mdash;found that 72.8% of infant food pouches had added sugar\u003csup\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/sup\u003e. By contrast, a United Kingdom audit\u0026mdash;using the World Health Organization Nutrient and Promotion Profile Model definition, which does not include fruit pur\u0026eacute;e as an added sugar\u0026mdash;found only 1% of infant and toddler food pouches had \u003cem\u003eadded\u003c/em\u003e sugar, despite 58% being high in energy from \u003cem\u003etotal\u003c/em\u003e sugars\u003csup\u003e(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)\u003c/sup\u003e. Regardless of technical definitions, professional health associations advise limiting food pouches to avoid high total sugars intake, not just free or added sugars intake, and associated health concerns\u003csup\u003e(\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe presence of caries in early childhood differed by child and carer ethnicity, carer education, and childcare use. Caries-positive children had lower vitamin A intake and marginally lower calcium intake than caries-free children, but were at no greater risk of inadequate intake. Feeding behaviours, including the current frequency of baby food pouch use, were not predictors of ECC. Product audits have highlighted the increasing presence and availability of pouch foods, and as such, further empirical research that examines the long term impact on dental health of frequent food pouch use, including pouch type by food group, is required.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical standards disclosure: This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the University of Otago Human Research Ethics Committee (H20/040). Written informed consent was obtained from all adult participants on behalf of their children.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChandan SN, Rao S (2023) Dietary interventions and nutritional impact on oral health and development: a review. 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N Z Dent J 115:133\u0026ndash;150\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"178bee33-83ee-4ee1-8024-f4d89656c833","identifier":"10.13039/501100000925","name":"National Health and Medical Research Council","awardNumber":"GA189596","order_by":0},{"identity":"577f6c9e-113a-43d5-91cb-006415254987","identifier":"10.13039/501100001505","name":"Health Research Council of New Zealand","awardNumber":"19-172","order_by":1},{"identity":"e69b5716-24f7-45f7-9998-22f25d9aabab","identifier":"10.13039/100008247","name":"University of Otago","awardNumber":"Doctoral Scholarship","order_by":2},{"identity":"dee9c96c-597e-44f6-a932-c9af078ed988","identifier":"10.13039/501100001554","name":"Massey University","awardNumber":"Doctoral Scholarship","order_by":3}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Ministry for Primary Industries","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"dietary intake, food pouches, early childhood caries, child health","lastPublishedDoi":"10.21203/rs.3.rs-8704660/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8704660/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: To describe predictors of early childhood caries (ECC, i.e. tooth decay in primary teeth) in toddlers and preschoolers.\u003c/p\u003e\n\u003cp\u003eDesign: The Young Foods New Zealand study was a cross-sectional observational study, including a questionnaire for sociodemographic information, oral hygiene practices, and feeding practices, such as food pouch use; measurement of anthropometry; nutrient intake from two 24-hour dietary recalls; and ECC status from dental photographs. Differences between caries-free and caries-positive children were estimated using regression analysis, adjusted for age.\u003c/p\u003e\n\u003cp\u003eSetting: Community study, New Zealand.\u003c/p\u003e\n\u003cp\u003eParticipants: 259 children aged 1.0 to 3.9 years.\u003c/p\u003e\n\u003cp\u003eResults: In total, 13.9% of children had ECC. Having ECC was associated with child and carer ethnicity, carer education, childcare use, and current breastfeeding status. Food pouch use, direct feeding from a food pouch nozzle, and weight status were not significantly associated with ECC status. Nutrient intakes were similar in those with and without ECC, including sugars intake. Caries-positive children had lower mean vitamin A (432 vs 526 µg, p=0.004) and marginally lower calcium (634 vs 715 mg, p=0.072) intake, compared to caries-free children, but were at no greater risk of inadequate intake.\u003c/p\u003e\n\u003cp\u003eConclusions: ECC status was associated with demographic characteristics but not current use of food pouches, in contrast to expectations that pouch use may adversely impact child dental health through exposure to sugary foods. Children with ECC largely met nutritional requirements but had lower vitamin A and calcium intakes.\u003c/p\u003e","manuscriptTitle":"Sociodemographic factors but not food pouch usage associated with early childhood caries in New Zealand children: Young Foods New Zealand study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-29 16:26:05","doi":"10.21203/rs.3.rs-8704660/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c2426ac0-31ae-4b57-be0f-078c1bd44e6e","owner":[],"postedDate":"January 29th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":61786340,"name":"Nutrition \u0026 Dietetics"},{"id":61786341,"name":"Dentistry"}],"tags":[],"updatedAt":"2026-01-29T16:26:06+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-29 16:26:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8704660","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8704660","identity":"rs-8704660","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}