Epidemiology, Dentistry, Pediatrics, Perinatology and Child Health
17
Scopus Publications
Scopus Publications
Low socioeconomic status, insulin resistance, asthma, and depression: A syndemic framework in Brazilian adolescents Aline Sousa Falcão, Lorena Lúcia Costa Ladeira, Susilena Arouche Costa, Rosângela Fernandes Lucena Batista, Claudia Maria Coelho Alves, Erika Bárbara Abreu Fonseca Thomaz, Cecília Claudia Costa Ribeiro Pediatric Allergy and Immunology, 2026 Background Adolescence is a critical developmental stage during which environmental, metabolic, and psychosocial factors co‐occur and may interact, influencing health and creating a syndemic context that remains insufficiently explored. Objective We analyzed a syndemic model, considering socioeconomic determinants and metabolic risk associated with asthma and depression in adolescents. Methods This population‐based study ( n = 2515) utilized data from the RPS Brazilian Consortium Cohorts at follow‐up of 18–19 years in São Luís, Brazil. A theoretical model analyzed the association among socioeconomic determinants, metabolic risk, asthma, and depression using Structural Equation Modeling (SEM). Low Socioeconomic Status was a distal determinant. The metabolic risk included the TG/HDL ratio, as an insulin resistance marker, as well as obesity. Asthma was a latent variable based on wheezing, asthma history, medical diagnosis, and frequency of wheezing. Depression was diagnosed based on major and recurrent episodes using the M.I.N.I. Results Low socioeconomic status was associated with higher insulin resistance precursor (TG/HDL ratio) (standardized coefficient, SC = 0.064; p = .027) and with higher levels of depression (SC = 0.084; p = .001). Higher insulin resistance precursor was associated with asthma (SC = 0.069; p = .042). Asthma was associated with depression (SC = 0.078; p < .001). Lower insulin resistance precursor levels were observed in girls (SC = −0.254; p < .001); meanwhile, obesity (SC = 0.124; p < .001) and depression (SC = 0.165; p < .001) had higher values for them. Conclusion Our findings underscore interconnected issues of low socioeconomic status, metabolic risk, asthma, and depression in adolescents. Recognizing the syndemic framework can lead to more effective health policies to prevent long‐term physical and mental health consequences.
Depression and caries in adolescents: role of social inequities and sugar consumption Ronaldo Nogueira Filho, Lorena Lúcia Costa Ladeira, Izabel Cristina Vieira de Oliveira, Luiza Jesus de Queiroz, Caroline Cabral Santos, Claudia Maria Coelho Alves, Erika Bárbara Abreu Fonseca Thomaz, Cecília Cláudia Costa Ribeiro Clinical Oral Investigations, 2026 Caries and depression are prevalent non-communicable diseases among adolescents that may share common risk factors. This study investigated the correlation between dental caries and depression in adolescents, analyzing pathways triggered by low socioeconomic status and higher sugar consumption. This population-based sample with a cross-sectional design using data from the birth cohort at the follow-up at 18 to 19 years (n = 2515). Low Socioeconomic Status was treated as a latent variable, and sugar consumption was measured in grams (< 25 g/day). Caries diagnosis was assessed using the DMFT index, and depression using the M.I.N.I. questionnaire. The theoretical model explored caries and depression as outcomes, as well as the explanatory variables: socioeconomic status and added sugar consumption. Lower socioeconomic status was associated with higher sugar consumption (CP = 0.05; p < 0.001) and depression (CP = 0.088; p = 0.013). Sugar consumption had a direct effect on depression (CP = 0.075; p = 0.024) and the DFMT index (CP = 0.049; p = 0.016). The DMFT and depression were correlated (CP = 0.068; p = 0.041). Our findings suggest an association between tooth decay and depression in adolescents, driven by shared risk factors such as lower socioeconomic status and increased sugar consumption. Implementing early intervention strategies targeting these shared risk factors is essential for mitigating the burden of chronic diseases.
Behavior Risk Factors for Noncommunicable Diseases and Caries in Adolescents: A Population Study Edna Luisa Oliveira Monteiro, Lorena Lúcia Costa Ladeira, Cayara Mattos Costa, Mylla Cristie Campelo Monteiro, Maria Augusta Bessa Rebelo, Claudia Maria Coelho Alves, Erika Barbara Abreu Fonseca Thomaz, Cecilia Claudia Costa Ribeiro Caries Research, 2025 Introduction: Caries is the most widespread non-communicable disease (NCD) globally and can predict fatality NCDs in the future, such as diabetes and cardiovascular diseases. Therefore, we hypothesized that the behavioral risk factors for those NCDs may be present in adolescents with caries. Objective: To analyze the association of unhealthy diet, tabagism, and alcohol with caries in adolescents. Methods: This population-based study with a cross-sectional design used data from 2515 adolescents aged 18-19 yo, born in São Luís-MA, Brazil, and part of the RPS Cohort Consortium. The exposures were the latent variables of the Unhealthy Diet Pattern (sugars, fast foods, and salty snacks) and Addictive Behaviors (tabagism and risk of alcohol dependence). The outcome was the number of decayed teeth. The model adjustment considered the Socioeconomic Status (head of household education, adolescent education, economic class, and monthly family income) as a distal determinant and the oral biofilm as a mediator between the exposures and the outcome, analyzed by Structural Equation Modeling (SEM), using the Mplus 8.0 software. Results: Unhealthy Diet Pattern was associated with a higher number of decayed teeth directly (SC=0.092, p≤0.001) and indirectly via dental biofilm (SC=0.020, p≤0.001). Addictive Behaviors were associated with a higher number of decayed teeth indirectly via dental biofilm (SC=0.019, p=0.013). The Unhealthy Diet Pattern and Addictive Behaviors were associated with each other (CP=0,199; p<0,001). Conclusion: Besides sugars, other behavioral risk factors for NCDs underlie caries, emphasizing the importance of comprehensive adolescent health care.
Molar Incisor Hypomineralization and Periodontitis in Adolescents: A Population-Based Study Marcela Mayana Pereira Franco, Cecilia Claudia Costa Ribeiro, Lorena Lúcia Costa Ladeira, Mario Augusto Brondani, Erika Bárbara Abreu Fonseca Thomaz, Cláudia Maria Coelho Alves Journal of Clinical Periodontology, 2025 AimTo investigate the association between molar incisor hypomineralization (MIH) and periodontitis in adolescents.MethodsA population‐based study was undertaken of Brazilian adolescents aged 18 and 19 years (n = 2515). MIH was assessed according to Ghanim's criteria. The outcomes were Periodontitis Indicators, a continuous latent variable estimated on the basis of the common variance shared by the indicators bleeding on probing (BoP), probing pocket depth (PPD ≥ 4 mm) and clinical attachment level (CAL ≥ 3 mm), as well as periodontitis cases defined according to CDC‐AAP. Structural equation modelling was used, and the models were adjusted for lower socioeconomic status, sex, smoking, triglycerides/high‐density lipoprotein (TG/HDL) (mg/dL) and visible plaque index. Two other approaches were used for sensitivity analysis: (i) logistic regression, considering the effect of MIH on periodontitis (CDC/AAP) at the individual level, and (ii) multilevel regression to evaluate the association of MIH with CAL and PPD, considering the tooth as the unit of analysis, adjusted for other tooth‐level and individual‐level variables.ResultsThe prevalence of MIH was 16.86% (n = 423). Individuals with MIH had higher values of the Periodontitis Indicators through a direct pathway (standardized coefficient [SC] = 0.193, p < 0.001) and indirectly mediated by biofilm (SC = 0.263, p < 0.001). MIH was also associated with periodontitis according to CDC‐AAP (SC = 0.071, p < 0.001) and indirectly mediated by biofilm (SC = 0.344, p < 0.001). Consistently, lower socioeconomic status, sex, TG/HDL and biofilm were associated with both periodontal outcomes. Tooth‐level sensitivity regression analysis confirmed the association observed in individual‐level analyses.ConclusionOur findings suggest that adolescents with MIH are susceptible to periodontitis, and it is therefore important to monitor their periodontal health.
Metabolic Dysfunction as a Common Pathway Linking Fatty Liver Disease and Periodontitis Maria Fernanda Sousa Vieira, Cecília Claudia Costa Ribeiro, Fabio Renato Manzolli Leite, Lorena Lúcia Costa Ladeira, Susilena Arouche Costa Oral Diseases, 2025 The data that support the findings of this study are openly available in National Health and Nutrition Examination Survey at https://www.cdc.gov/nchs/nhanes/index.html.
Structural validity of the Brazilian version of the quality care questionnaire-palliative care for use in individuals with diabetes mellitus eligible for palliative care Abraão Albino Mendes-Júnior, Aldair Darlan Santos-de-Araújo, Leonel Richard de Oliveira Silva Santos, Lorena Lúcia Costa Ladeira, Meire Coelho Ferreira, Louise Aline Romão Godim, Mariana Campos Maia, Marinete Rodrigues de Farias Diniz, Almir Vieira Dibai-Filho, Daniela Bassi-Dibai Diabetology and Metabolic Syndrome, 2024 Background The Brazilian version of the Quality Care Questionnaire-Palliative Care (QCQ-PC) is an instrument designed to assess the quality of care provided in palliative care from the user’s perspective, featuring easy comprehension and applicability. It has demonstrated validity for use in individuals with cancer, but there is a need for validation in other populations due to the scarcity of instruments with this purpose. Objective To structurally validate the Brazilian version of the QCQ-PC for use in individuals with diabetes mellitus (DM) eligible for palliative care. Methods This is a structural validation study of a questionnaire according to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). The study was conducted with 100 individuals with DM. Data collection occurred in differents care services in São Luís (northeast Brazil) by means of the application of the QCQ-PC and a form with sociodemographic, clinical, and daily habit data. Descriptive data analysis was performed using absolute values, relative frequencies, and measures of central tendency and dispersion. Structural validity was assessed by means of exploratory factor analysis (EFA). Results Of the 100 participants included in the study, 66% were female, 54% were single, with a median age of 64 years, 44% were overweight (44%), 77% were on polypharmacy, and 70% were physically inactive. We found that one domain is the most appropriate for use of the QCQ-PC in individuals with DM eligible for palliative care, according to the parallel analysis implemented in the EFA. This domain was named “quality of care”. The fit indices for this one-dimensional internal structure were adequate: Kaiser–Meyer–Olkin test = 0.71, p value < 0.01 in Bartlett’s test, chi-square/degree of freedom = 1.07, comparative fit index = 0.993, Tucker-Lewis index. = 0.991, root mean square error of approximation = 0.028. The QCQ-PC presented factor loadings ranging from 0.480 to 0.883, maintaining a total of 12 items, which demonstrates the adequate relationship between the quality of care domain and its items. Conclusion Therefore, the internal structure with one domain (quality of care) is the most suitable for use in individuals with DM eligible for palliative care by means of the QCQ-PC.
High free sugars, insulin resistance, and low socioeconomic indicators: the hubs in the complex network of non-communicable diseases in adolescents Silas Alves-Costa, Bruno Feres de Souza, Francisco Aparecido Rodrigues, Alexandre Archanjo Ferraro, Gustavo G. Nascimento, Fabio R. M. Leite, Lorena Lúcia Costa Ladeira, Rosângela Fernandes Lucena Batista, Erika Bárbara Abreu Fonseca Thomaz, Claudia Maria Coelho Alves, Cecilia Claudia Costa Ribeiro Diabetology and Metabolic Syndrome, 2024 BACKGROUND: Noncommunicable diseases (NCDs) predominantly affect adults, but pathophysiological changes begin decades earlier, as a continuum, with initial events apparent in adolescence. Hence, early identification and intervention are crucial for the prevention and management of NCDs. We investigated the complex network of socioeconomic, behavioral, and metabolic factors associated with the presence of NCD in Brazilian adolescents. METHODS: We conducted a cross-sectional study nested within the São Luís segment of the Ribeirão Preto, Pelotas, and São Luís (RPS) cohort's consortium, focusing on 18-19-year-olds (n = 2515). Data were collected prospectively, from which we constructed a complex network with NCD-related factors/indicators as nodes and their co-occurrences as edges. General and sex-based models analyzed: socioeconomic status, behavioral (smoking, alcohol, and other drugs use, unhealthy diet, poor sleep, physical inactivity), and metabolic factors (overweight/obesity, elevated blood pressure, poor lipid profile). We also looked for NCDs in adolescence like asthma, abnormal spirometry, depression, suicide risk, and poor oral health. The network was characterized by degree, betweenness, eigenvector, local transitivity, Shannon entropy, and cluster coefficient. RESULTS: The adolescents had an average age of 18.3 years, 52.3% were female and 47.7% male. 99.8% of them have a diet rich in free sugars, 15% are overweight/obese and 72.3% had an elevated TyG index. High free sugar emerged as the central hub, followed by high TyG index (an early marker of insulin resistance) and low socioeconomic class. In males, low fiber intake and a high triglycerides/HDL ratio highlighted cardiometabolic concerns; in females, sedentary behavior and poor sleep marked metabolic and psychological challenges, along with caries in both sexes. CONCLUSIONS: Our findings provide insights into central health challenges during adolescence, such as high free sugars, insulin resistance, and low socioeconomic indicators, suggesting that interventions targeted at these central hubs could have a significant impact on their NCD network.
Chronic oral disease burden at the first 1000 days: Intergenerational risk factors, BRISA cohort Sângela Maria Pereira Araújo, Gustavo G. Nascimento, Lorena Lucia Costa Ladeira, Silas Alves‐Costa, Maria Conceição Saraiva, Claudia Maria Coelho Alves, Erika Bárbara Abreu Fonseca Thomaz, Cecilia Claudia Costa Ribeiro Oral Diseases, 2024 ObjectiveTo analyze multiple‐causal models, including socioeconomic, obesity, sugar consumption, alcohol smoking, caries, and periodontitis variables in pregnant women with early sugar exposure, obesity, and the Chronic Oral Disease Burden in their offspring around the first 1000 days of life.MethodsThe BRISA cohort study, Brazil, had two assessments: at the 22nd–25th gestational weeks and during the child's second year (n = 1141). We proposed a theoretical model exploring the association between socioeconomic and pregnancy factors (age, smoking, alcohol, sugars, obesity, periodontitis, and caries) and child's variables (sugars and overweight) with the outcome, Chronic Oral Disease Burden (latent variable deduced from visible plaque, gingivitis, and tooth decay), using structural equation modeling.ResultsCaries and periodontitis were correlated in pregnant women. Addictive behaviors in the gestational period were correlated. Obesity (Standardized coefficient ‐ SC = 0.081; p = 0.047) and added sugar consumption (SC = 0.142; p = 0.041) were observed intergenerationally in the pregnant woman‐child dyads. Sugar consumption by the children (SC = 0.210; p = 0.041) increased the Chronic Oral Disease Burden.ConclusionsPoor caries and periodontal indicators were correlated in pregnant women and their offspring. Obesity and sugar consumption act intergenerationally. Oral health in early life may change life trajectory since the worst oral conditions predict main NCDs.
Pre- and perinatal exposures associated with molar incisor hypomineralization: Birth cohort, Brazil Marcela M. P. Franco, Cecilia C. C. Ribeiro, Lorena L. C. Ladeira, Erika Bárbara Abreu Fonseca Thomaz, Claudia Maria Coelho Alves Oral Diseases, 2024 ObjectiveTo analyze prenatal and perinatal stressors associated with molar incisor hypomineralization (MIH) in adolescents.MethodsProspective cohort study collected prenatal (socioeconomic status, maternal age, number of prenatal visits, smoking, obesity during pregnancy, abortion history, gestational hypertension) and perinatal stressors (type of delivery, gestational age, birth weight, intensive care unit‐ICU at birth). The outcome was MIH at 18–19 years follow‐up (n = 590). MIH was defined according to the Ghanim criteria – Model I. We performed a sensitivity analysis, including opacities demarcated in index tooth, incisive or molars, Model II. Through structural equation modeling, we analyzed direct and mediating pathways between multiple stressors with outcomes.ResultsMIH was observed in 15.25% (n = 90), and opacities demarcated in any index tooth were observed in 22.8% of adolescents (n = 135). In Model I, no stressor explained MIH significantly, although we watched high standardized coefficients (SC) for low birth weight (SC = 0.223, p = 0.147), lower gestational age (SC = 0.351; p = 0.254), and ICU admission (SC = 0.447, p = 0.254). In Model II, advanced maternal age (SC = 0.148; p < 0.05) and not undergoing prenatal care (SC = 0.384, p < 0.03) explained opacities demarcated in incisors or molars.ConclusionAdvanced maternal age and not undergoing prenatal care were associated with MIH lesion‐like in incisors or molars.
Sugar intake above international recommendations and oral disease burden: A population-based study Lorena Lucia Costa Ladeira, Gustavo G. Nascimento, Fabio Renato Manzolli Leite, Silas Alves‐Costa, Erika Bárbara Abreu Fonseca Thomaz, Claudia Maria Coelho Alves, Jaime Aparecido Cury, Cecilia Claudia Costa Ribeiro Oral Diseases, 2024 ObjectiveTo evaluate the association between added sugar intake above the daily limit for the risk of noncommunicable diseases (NCDs) and the Chronic Oral Disease Burden in adolescents.MethodsThis was a population‐based study using cross‐sectional data nested to RPS Cohorts Consortium, São Luís, Brazil, from the 18–19‐year‐old follow‐up (n = 2515). High consumption of added sugars was estimated according to the limits of the World Health Organization guidelines (WHO) (≥5% of total energy/day) and the American Heart Association statement (AHA) (≥25 g/day). The Chronic Oral Disease Burden was a latent variable (number of decayed teeth, periodontal probing depth ≥4 mm, clinical attachment level ≥3 mm, and bleeding on probing). Models were adjusted for Socioeconomic Status, sex, obesity, and plaque index and analyzed through structural equation modeling.ResultsAdolescents had high sugar consumption according to the WHO (78.6%) and AHA (81.4%) recommendations. High sugar intake, according to WHO (SC = 0.096; p = 0.007) and AHA (SC = 0.056; p = 0.027), was associated with a heavier Chronic Oral Disease Burden. Even half of the recommended dose was sufficient to affect some oral disease indicators.ConclusionSugar intake over international statements to prevent NCDs is associated with higher Chronic Oral Disease Burden among adolescents.
Higher sugar intake is associated with periodontal disease in adolescents Ana R. O. Moreira, Rosangela F. L. Batista, Lorena L. C. Ladeira, Erika B. A. F. Thomaz, Claudia M. C. Alves, Maria C. Saraiva, Antonio A. M. Silva, Mario A. Brondani, Cecilia C. C. Ribeiro Clinical Oral Investigations, 2021
