Snacking behaviors and early childhood caries severity among Myanmar preschool children: a cross-sectional study.

BACKGROUND: Early childhood caries (ECC) is highly prevalent among preschool children, particularly in Southeast Asian countries. Although dietary intake is a well-established risk factor, evidence on how specific snacking behaviors contribute to caries severity remains limited. This study examined the associations of food pocketing habit, main snack type, snack frequency, snack timing, and combined snacking patterns with ECC severity among Myanmar preschool children. METHODS: A cross-sectional analysis was performed using baseline data from an ongoing cohort study of 815 children aged 4-5 years from eight preschools in Yangon between December 2024 and February 2025. Dental caries was assessed using the International Caries Detection and Assessment System II (ICDAS II), with the highest per-child ICDAS II score (0-6) used as a continuous outcome. Parents completed structured questionnaires on sociodemographic characteristics, parental socioeconomic factors, oral health behaviors, and snacking behaviors. Children were further classified according to snack frequency (≤2 or ≥3 times/day) and timing (fixed or irregular) into four combined snacking pattern groups. Linear regression analyses were performed using four sequential adjustment models. RESULTS: Sweet snack consumption (86.4%) and irregular snack timing (80.2%) were highly prevalent. Food pocketing and main snack type were not significantly associated with caries severity in any model. Snack frequency and timing were each associated with ICDAS II scores across all models (fully adjusted: B = 0.3, 95%CI:0.1-0.6; and B = 0.4, 95%CI:0.2-0.7, respectively). Among combined snacking patterns, the ≥3 times/day and irregular timing group showed the most consistent association with higher caries severity across all models (fully adjusted: B = 0.8, 95%CI:0.4-1.1). CONCLUSION: Snack frequency, timing, and certain combined snacking patterns were associated with ECC severity. ECC prevention programs may consider addressing not only snack content but also the frequency and regularity of snacking.