{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T15:19:20Z","timestamp":1777562360142,"version":"3.51.4"},"reference-count":62,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,5,26]],"date-time":"2023-05-26T00:00:00Z","timestamp":1685059200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Aix-Marseille University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background: This paper aimed to study the association of serum Vitamin D level and Body Mass Index (BMI) as representatives of malnutrition at micro and macro levels, respectively, on dental caries. Method and Participants: A total of 333 randomly selected children aged 6\u201312 years in Sulaimani, Kurdistan, Iraq were examined for three variables of the Decayed Missed Filled Tooth (DMFT) index, BMI, and Vitamin D serum levels in a single-time cross-sectional snapshot. Results: The majority of the population studied (70%) were Vitamin D deficient. In the linear regression analysis, both Vitamin D and BMI had insignificant effects on DMFT, with p-values of 0.22 and 0.55, respectively. After the categorization of the data, the risk estimate between normal (\u226520 ng\/mL) and deficient (&lt;20 ng\/mL) Vitamin D groups with regards to the caries and caries-free categories was 1.97 (95% CI: 0.91\u20134.24). According to the mean and median of the DMFT, which were both 4, the sample is categorized into the low-caries group (DMFT &lt; 4) and high-caries group (DMFT &gt; 4). When these groups are compared to Vitamin D levels and taking 20 and 15 as thresholds, the odds ratios were 1.19 (CI: 0.74\u20131.92) and 1.88 (CI: 1.20\u20132.94), respectively. Regarding the BMI, a normal BMI increases the chances of having a lower caries index (OR = 1.83, CI: 1.10\u20133.03). Conclusions: Our results show that having a serum Vitamin D level \u226515 ng\/mL and having a normal BMI are associated with a lower caries index in children.<\/jats:p>","DOI":"10.3390\/dj11060141","type":"journal-article","created":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T16:10:53Z","timestamp":1685203853000},"page":"141","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Association between Malnutrition and Dental Caries in Iraqi Kurdish Children"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8093-9514","authenticated-orcid":false,"given":"Mohammed Khalid","family":"Mahmood","sequence":"first","affiliation":[{"name":"Faculty of Dentistry, Aix-Marseille University, CNRS, EFS, ADES, 13284 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Romain","family":"Lan","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, Aix-Marseille University, CNRS, EFS, ADES, 13284 Marseille, France"},{"name":"Odontology Department, Timone Hospital, 13284 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Herve","family":"Tassery","sequence":"additional","affiliation":[{"name":"Ecole de M\u00e9decine Dentaire de Marseille, Universit\u00e9 d\u2019Aix-Marseille, 13385 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Delphine","family":"Tardivo","sequence":"additional","affiliation":[{"name":"Odontology Department, Timone Hospital, 13284 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,26]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Dental caries","volume":"3","author":"Pitts","year":"2017","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/j.1875-595X.2008.tb00185.x","article-title":"World Health Organization global policy for improvement of oral health-World Health Assembly 2007","volume":"58","author":"Petersen","year":"2008","journal-title":"Int. Dent. J."},{"key":"ref_3","first-page":"1","article-title":"Pathophysiology of dental caries","volume":"Volume 27","author":"Conrads","year":"2018","journal-title":"Caries Excavation: Evolution of Treating Cavitated Carious Lesions"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1177\/0022034515605281","article-title":"Gene-environment interactions in the etiology of dental caries","volume":"95","author":"Yildiz","year":"2016","journal-title":"J. Dent. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"624","DOI":"10.7861\/clinmedicine.10-6-624","article-title":"Malnutrition: Causes and consequences","volume":"10","author":"Saunders","year":"2010","journal-title":"Clin. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1017\/S0031182000006478","article-title":"Global malnutrition","volume":"121","author":"Stephenson","year":"2000","journal-title":"Parasitology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"518","DOI":"10.5114\/ceji.2014.47738","article-title":"Host response, malnutrition and oral diseases. Part 1","volume":"39","author":"Slotwinska","year":"2014","journal-title":"Cent. Eur. J. Immunol."},{"key":"ref_8","first-page":"2206","article-title":"Malnutrition and diet role in prevention of oral disease","volume":"18","author":"Alotaibi","year":"2019","journal-title":"EC Dent. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1159\/000088178","article-title":"Malnutrition and dental caries: A review of the literature","volume":"39","author":"Psoter","year":"2005","journal-title":"Caries Res."},{"key":"ref_10","first-page":"178","article-title":"Malnutrition and its oral outcome\u2014A review","volume":"7","author":"Sheetal","year":"2013","journal-title":"J. Clin. Diagn. Res. JCDR"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1258\/RSMSMJ.51.3.26","article-title":"Dietary and social characteristics of children with severe tooth decay","volume":"51","author":"Cameron","year":"2006","journal-title":"Scott. Med. J."},{"key":"ref_12","first-page":"209","article-title":"The effect of nursing or rampant caries on height, body weight and head circumference","volume":"20","author":"Ayhan","year":"1996","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ferrazzano, G.F., Salerno, C., Sangianantoni, G., Caruso, S., Ingenito, A., and Cantile, T. (2020). The effect of dental treatment under general anesthesia on quality of life and growth and blood chemistry parameters in uncooperative pediatric patients with compromised oral health: A pilot study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17124407"},{"key":"ref_14","unstructured":"De Onis, M., Blossner, M., and World Health Organization (1997). WHO Global Database on Child Growth and Malnutrition, World Health Organization."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1080\/10408398.2012.688897","article-title":"Vitamin D bioavailability: State of the art","volume":"55","author":"Borel","year":"2015","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1056\/NEJMra070553","article-title":"Vitamin D deficiency","volume":"357","author":"Holick","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.jsbmb.2013.11.003","article-title":"Is vitamin D deficiency a major global public health problem?","volume":"144","author":"Palacios","year":"2014","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.ijpp.2018.07.001","article-title":"The rachitic tooth: Refining the use of interglobular dentine in diagnosing vitamin D deficiency","volume":"22","author":"Kahlon","year":"2018","journal-title":"Int. J. Paleopathol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1210\/er.2013-1009","article-title":"The rachitic tooth","volume":"35","author":"Foster","year":"2014","journal-title":"Endocr. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1146\/annurev.med.051308.111339","article-title":"Regulation of phosphate homeostasis by PTH, vitamin D, and FGF23","volume":"61","author":"Bergwitz","year":"2010","journal-title":"Annu. Rev. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1159\/000223685","article-title":"Physiology of calcium, phosphate and magnesium","volume":"16","author":"Allgrove","year":"2009","journal-title":"Calcium Bone Disord. Child. Adolesc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e1277","DOI":"10.1542\/peds.2013-2215","article-title":"Prenatal vitamin D and dental caries in infants","volume":"133","author":"Schroth","year":"2014","journal-title":"Pediatrics"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1177\/0022034519834518","article-title":"Association of maternal vitamin D deficiency with early childhood caries","volume":"98","author":"Singleton","year":"2019","journal-title":"J. Dent. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1210\/jcem-59-4-652","article-title":"Evaluation of the total fetomaternal vitamin D relationships at term: Evidence for racial differences","volume":"59","author":"Hollist","year":"1984","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1177\/1759720X16656810","article-title":"Maternal vitamin D levels during pregnancy and neonatal health: Evidence to date and clinical implications","volume":"8","author":"Karras","year":"2016","journal-title":"Ther. Adv. Musculoskelet. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1001\/jamapediatrics.2019.2545","article-title":"Association of high-dose vitamin D supplementation during pregnancy with the risk of enamel defects in offspring: A 6-year follow-up of a randomized clinical trial","volume":"173","author":"Haubek","year":"2019","journal-title":"JAMA Pediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1159\/000502793","article-title":"Toward preventing enamel hypoplasia: Modeling maternal and neonatal biomarkers of human calcium homeostasis","volume":"54","author":"Reed","year":"2020","journal-title":"Caries Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.pdj.2016.08.001","article-title":"Prenatal vitamin D and enamel hypoplasia in human primary maxillary central incisors: A pilot study","volume":"27","author":"Reed","year":"2017","journal-title":"Pediatr. Dent. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.annepidem.2015.03.020","article-title":"Higher vitamin D intake during pregnancy is associated with reduced risk of dental caries in young Japanese children","volume":"25","author":"Tanaka","year":"2015","journal-title":"Ann. Epidemiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1111\/j.1753-4887.2012.00544.x","article-title":"Vitamin D and dental caries in controlled clinical trials: Systematic review and meta-analysis","volume":"71","author":"Hujoel","year":"2013","journal-title":"Nutr. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Jagelavi\u010dien\u0117, E., Vaitkevi\u010dien\u0117, I., \u0160ilingait\u0117, D., \u0160ink\u016bnait\u0117, E., and Daug\u0117lait\u0117, G. (2018). The relationship between vitamin D and periodontal pathology. Medicina, 54.","DOI":"10.3390\/medicina54030045"},{"key":"ref_32","first-page":"204","article-title":"Prevalence of developmental enamel defects and dental caries in rural pre-school Thai children","volume":"13","author":"Kanchanakamol","year":"1996","journal-title":"Community Dent. Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"493","DOI":"10.14219\/jada.archive.2007.0201","article-title":"The relationship between nutrition and systemic and oral well-being in older people","volume":"138","author":"Moynihan","year":"2007","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.jdent.2014.03.005","article-title":"Comparison of functionally orientated tooth replacement and removable partial dentures on the nutritional status of partially dentate older patients: A randomised controlled clinical trial","volume":"42","author":"McKenna","year":"2014","journal-title":"J. Dent."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1017\/S1368980013000177","article-title":"Predicted vitamin D status and incidence of tooth loss and periodontitis","volume":"17","author":"Jimenez","year":"2014","journal-title":"Public Health Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Botelho, J., Machado, V., Proen\u00e7a, L., Delgado, A.S., and Mendes, J.J. (2020). Vitamin D Deficiency and Oral Health: A Comprehensive Review. Nutrients, 12.","DOI":"10.3390\/nu12051471"},{"key":"ref_37","first-page":"295","article-title":"Correlation between oral health and body mass index (BMI) in 2071 primary school pupils","volume":"12","author":"Willershausen","year":"2007","journal-title":"Eur. J. Med. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/cdoe.12014","article-title":"Obesity and dental caries in children: A systematic review and meta-analysis","volume":"41","author":"Hayden","year":"2013","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_39","first-page":"137","article-title":"Obesity and dental caries\u2014A systematic review","volume":"4","author":"Kantovitz","year":"2006","journal-title":"Oral Health Prev. Dent."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1159\/000484988","article-title":"Association between dental caries and BMI in children: A systematic review and meta-analysis","volume":"52","author":"Chen","year":"2018","journal-title":"Caries Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1111\/j.1600-0528.2007.00421.x","article-title":"Dental caries and body mass index by socio-economic status in Swedish children","volume":"36","author":"Gerdin","year":"2008","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"564","DOI":"10.2307\/2091346","article-title":"Sampling organizations and groups of unequal sizes","volume":"30","author":"Kish","year":"1965","journal-title":"Am. Sociol. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"307","DOI":"10.32007\/jfacmedbagdad.4931353","article-title":"Malnutrition among first year school children in Iraq","volume":"49","year":"2007","journal-title":"J. Fac. Med. Baghdad"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Beckett, D.M., Broadbent, J.M., Loch, C., Mahoney, E.K., Drummond, B.K., and Wheeler, B.J. (2022). Dental Consequences of Vitamin D Deficiency during Pregnancy and Early Infancy\u2014An Observational Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19041932"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"240","DOI":"10.4103\/jisppd.jisppd_457_20","article-title":"Association of serum Vitamin D and salivary calcium and phosphorus levels in 3-11-year-old schoolchildren with dental caries","volume":"39","author":"Pratyusha","year":"2021","journal-title":"J. Indian Soc. Pedod. Prev. Dent."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1210\/jc.2011-2218","article-title":"IOM committee members respond to Endocrine Society vitamin D guideline","volume":"97","author":"Rosen","year":"2012","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_47","unstructured":"Cogill, B. (2003). Anthropometric Indicators Measurement Guide, Food and Nutrition Technical Assistance Project, Academy for Educational Development."},{"key":"ref_48","unstructured":"Unicef (2018). Levels and Trends in Child Malnutrition, eSocialSciences."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1993","DOI":"10.1093\/jn\/nxab075","article-title":"Associations between prenatal, perinatal, and early childhood vitamin d status and risk of dental caries at 6 years","volume":"151","author":"Navarro","year":"2021","journal-title":"J. Nutr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"75","DOI":"10.4103\/0976-6944.119937","article-title":"Vitamin D deficiency and risk of dental caries among young children: A public health problem","volume":"4","author":"Bener","year":"2013","journal-title":"Indian J. Oral Sci."},{"key":"ref_51","unstructured":"Herzog, K. (2015). Association of Vitamin D and Dental Caries in Children Using NHANES 2005\u20132006 Data. [Master\u2019s Thesis, University of Washington]."},{"key":"ref_52","first-page":"535","article-title":"Seasonal Variations in Serum Vitamin D According to Age and Sex","volume":"3","author":"Heidari","year":"2012","journal-title":"Casp. J. Intern. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1007\/s12020-017-1292-7","article-title":"Impact of season and different vitamin D thresholds on prevalence of vitamin D deficiency in epidemiological cohorts\u2014A note of caution","volume":"56","author":"Schramm","year":"2017","journal-title":"Endocrine"},{"key":"ref_54","first-page":"12","article-title":"Vitamin D level study within the population in Sulaymaniyah City-IRAQ","volume":"11","author":"Abdullah","year":"2018","journal-title":"Mult. Scler."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"119","DOI":"10.4103\/MJBL.MJBL_9_19","article-title":"Prevalence of Vitamin D deficiency in Iraqi female at reproductive age","volume":"16","author":"Hantoosh","year":"2019","journal-title":"Med. J. Babylon"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1056\/NEJMp1608005","article-title":"Vitamin D deficiency-is there really a pandemic","volume":"375","author":"Manson","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"675403","DOI":"10.3389\/fpubh.2021.675403","article-title":"Vitamin D status and its influence on the health of preschool children in Hangzhou","volume":"9","author":"Chen","year":"2021","journal-title":"Front. Public Health"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1016\/j.adaj.2022.03.008","article-title":"The association between vitamin D levels and caries experience in children and youth participating in National Health and Nutrition Examination Survey 2011\u20132016: A cross-sectional study","volume":"153","author":"Herzog","year":"2022","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"5","DOI":"10.5339\/qmj.2017.5","article-title":"Malnutrition trends in preschool children from a primary healthcare center in Baghdad: A comparative two-year study (2006 and 2012)","volume":"2017","author":"Arif","year":"2017","journal-title":"Qatar Med. J."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e10563","DOI":"10.2196\/10563","article-title":"Malnutrition Among Under Five Children in Iraq, 2002\u20132016","volume":"4","author":"Malik","year":"2018","journal-title":"Iproceedings"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1007\/s10389-016-0745-4","article-title":"Constructing public health policies in post crisis countries: Lessons to learn from the associations between free-sugars consumption and diabetes, obesity and dental caries before, during and after sanctions in Iraq","volume":"24","author":"Joury","year":"2016","journal-title":"J. Public Health"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"228","DOI":"10.5005\/jp-journals-10005-1516","article-title":"Body mass index and dental caries: A systematic review","volume":"11","author":"Shivakumar","year":"2018","journal-title":"Int. J. Clin. Pediatr. Dent."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/11\/6\/141\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:42:43Z","timestamp":1760125363000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/11\/6\/141"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,26]]},"references-count":62,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["dj11060141"],"URL":"https:\/\/doi.org\/10.3390\/dj11060141","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,26]]}}}