{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T06:17:55Z","timestamp":1778566675170,"version":"3.51.4"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100022771","name":"Borrow Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022771","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oral Health"],"abstract":"\n Background<\/jats:title>\n Excessive intake of free sugars in early childhood is a major modifiable risk factor for early childhood caries (ECC). Evidence on geographic variation in sugar consumption among preschool children remains limited, particularly in Eastern Europe.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To assess patterns of sugar intake among Romanian preschool children and to explore non-linear and spatial associations between sugar consumption and geographic areas using advanced statistical and mapping techniques.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Baseline data from the Smilebright Romania oral health programme were analyzed for 391 children aged 4\u20135 years. Parental questionnaires assessed the frequency of consumption of natural and processed sugars using a Likert scale. Sugar intake indices (total, processed, and natural) were derived as mean frequency scores. Non-linear associations between sugar intake and geographic variables were explored using locally weighted scatterplot smoothing (LOESS) and tested using generalized additive models (GAMs). County-level mean intake values were visualized using choropleth maps.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n At the macro-regional level, significant variation was observed only for natural sugar intake (edf\u2009=\u20091.69, F\u2009=\u20097.32,\n p<\/jats:italic>\n \u2009&lt;\u20090.01), while processed and total sugar intake showed no significant differences. At the county level, significant geographic variation was identified for total, processed, and natural sugar intake (all\n p<\/jats:italic>\n \u2009&lt;\u20090.01), although adjusted R\n 2<\/jats:sup>\n values were modest (0.04\u20130.07). Spatial mapping revealed higher levels of total and processed sugar intake predominantly in north-eastern counties, whereas natural sugar intake was higher in south-western regions.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Sugar intake among Romanian preschool children demonstrates non-linear and spatially structured geographic patterns, particularly at finer geographic resolution. Although geographic factors explain a limited proportion of variability, their consistent influence supports the value of spatially informed analyses. Integrating flexible statistical modeling with geographic visualization can enhance understanding of dietary risk factors relevant to ECC prevention and inform targeted public health strategies details.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/froh.2026.1822133","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T05:44:36Z","timestamp":1778564676000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early childhood caries in Romania: non-linear and spatial analysis of geographic sugar intake using LOESS, GAMs, and choropleth mapping"],"prefix":"10.3389","volume":"7","author":[{"given":"Ruxandra","family":"Sava-Rosianu","sequence":"first","affiliation":[{"name":"Translational and Experimental Research Center in Oral Health, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara","place":["Timisoara, Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guglielmo Giuseppe","family":"Campus","sequence":"additional","affiliation":[{"name":"Department of Cariology, Institute of Odontology at Sahlgrenska Academin, University of Gothenburg","place":["Gothenburg, Sweden"]},{"name":"Department of Dental Sciences and Maxillo-Facial Surgery, Sapienza University of Rome","place":["Rome, Italy"]},{"name":"Department of Cariology, Saveetha Dental College and Hospitals, SIMATS","place":["Chennai, India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vlad Tiberiu","family":"Alexa","sequence":"additional","affiliation":[{"name":"Translational and Experimental Research Center in Oral Health, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara","place":["Timisoara, Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonia","family":"Ilin","sequence":"additional","affiliation":[{"name":"Translational and Experimental Research Center in Oral Health, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara","place":["Timisoara, Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana","family":"Postolache","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Medicine and Pharmacy Bucharest","place":["Bucharest, Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Jumanca","sequence":"additional","affiliation":[{"name":"Translational and Experimental Research Center in Oral Health, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara","place":["Timisoara, Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxana","family":"Oancea","sequence":"additional","affiliation":[{"name":"Translational and Experimental Research Center in Oral Health, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara","place":["Timisoara, Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruxandra","family":"Sfeatcu","sequence":"additional","affiliation":[{"name":"Department of Oral Health and Community Dentistry, Faculty of Dentistry, \u201cCarol Davila\u201d University of Medicine and Pharmacy","place":["Bucharest, Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana","family":"Caramida","sequence":"additional","affiliation":[{"name":"Department of Oral Health and Community Dentistry, Faculty of Dentistry, \u201cCarol Davila\u201d University of Medicine and Pharmacy","place":["Bucharest, Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandrina","family":"Muntean","sequence":"additional","affiliation":[{"name":"Department of Pedodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d","place":["Cluj-Napoca, Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Esian","sequence":"additional","affiliation":[{"name":"Department of Pedodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy","place":["Targu Mures, Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Murariu","sequence":"additional","affiliation":[{"name":"Department of Community Dentistry, Faculty of Dental Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d","place":["Iasi, Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constantin","family":"Daguci","sequence":"additional","affiliation":[{"name":"Department of Oro-Dental Prevention, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova","place":["Craiova, Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Octavia","family":"Balean","sequence":"additional","affiliation":[{"name":"Translational and Experimental Research Center in Oral Health, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara","place":["Timisoara, Romania"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Bolchis","sequence":"additional","affiliation":[{"name":"Translational and Experimental Research Center in Oral Health, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara","place":["Timisoara, 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