Collaborative study of fluoride intake and utilization in Hungary: introduction and background.
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Biomedical subjects
Publications and source records attributed to E Sugár.
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The F content of foods and beverages comprising a substantial proportion of the Hungarian diet has been determined. Vegetables and fruits grown in three areas where the mean F content of water was 0.09 mg/l, 0.81 mg/l and 1.91 mg/l did not reflect these differences. In contrast, the F content of cooking water has made demonstrable contribution to the F content of cooked foods. Significant elevation in F concentration was also found in some meat products, where the inclusion of bone dust or fragments is suggested by corresponding increase in Ca content.
Average daily dietary intakes of F were determined for 67 kindergarten children (X age 3.9 years) and 118 schoolchildren (X age 14.0 years), resident in one of three areas where the concentration of naturally occurring F in the household water ranged 0.06-0.11 mg/l, 0.05-1.10 mg/l and 1.6-3.1 mg/l. Mean daily F intakes increased consistently and significantly with increasing F content of the water in all dietary categories in both age groups. Due to relatively low water and high milk consumption, F from foods has made a greater contribution to total F intake (40-53% over the whole sample) than F in water ingested as such, or in beverages. The total amount of F ingested from dietary sources is considered safe even at the highest intake levels found (X = 0.44 mg/day, SD = 0.11 at 3.9 years; 1.49 mg/day, SD = 0.35 at 14.0 years).
The Al, Ca and Mg content of 147 kinds of foods and beverages, representing a large proportion of the Hungarian diet, has been determined using replicate samples. Dietary intakes of these minerals by 67 kindergarten children and 139 schoolchildren have been assessed. The richest sources of Al were: parsley, celery, gherkins, barley-malt; of Ca: dairy products, celery, parsley, savoy; of Mg: dried beans and peas, parsley, dill, maize-flour, rice, gherkins, chocolate. Flavouring agents (e.g. salt, pepper, paprika, caraway-seed) had very high concentrations of all three minerals and poppy-seeds that of Ca and Mg. The presence of bone-dust or fragments elevated the Ca content of some meats and cooked dishes. The main source of dietary intake of all three minerals was food; as opposed to F, the contribution of water-borne Al, Ca and Mg was negligible. Based on average values, the daily intake of all three minerals was satisfactory in both age groups. Mg intake was marginally below the recommended limit for a few children, but no signs of Mg deficiency were seen.
Selected interactions were examined between F, Al, Ca and Mg intakes and their manifestations in dental health parameters and biological samples relating to Hungarian children. The prevalence (DMFT, DMFS) and severity (SR) of caries were inversely related to the F concentration of household water and to the amount of F ingested from foods, beverages and tap or well water. Dental fluorosis and the F content of enamel, plaque, saliva, urine, nails and hair were directly related to the F content of water and to dietary F intake. The high significance levels and absolute consistency of associations lend strong support to the biological interdependence of the variables involved. In contrast, no associations were found between Mg ingestion and F utilization. Despite numerous inverse trends and some statistically significant inverse associations suggesting that dietary Al and Ca interfere with F uptake, the biological significance of the latter findings needs further exploration. Inhaled F amounted to less than 0.17% of the total F intake. The F content of frequently prescribed non-dental medicines ranged from below 0.00001 to 0.014 mg/g; their contribution to total F intake is considered insignificant.
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Individual samples of urine, fingernails, head-hair, saliva, plaque and enamel were collected from three groups of Hungarian children, aged 14 years, who were exposed to contrasting water fluoride levels (less than or equal to 0.11 ppm; 0.5-1.1 ppm; 1.6-3.1 ppm). The mean fluoride concentration of the samples increased consistently and significantly, but mostly non-proportionately, with increasing water fluoride level. With the exception of plaque, the materials examined are considered suitable indicators of exposure to or systemic utilization of fluoride for population groups. Caries experience decreased with increasing fluoride exposure. Dental fluorosis constituted no clinical or aesthetic problem.
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The F concentrations in plaque and in underlying enamel were determined in a sample of 99 schoolchildren aged 8.4 years (S.D. = 0.37), comprising four groups, exposed life-long to contrasting concentrations of F in the water (range less than or equal to 0.12 ppm to 2.8 ppm) and to supplements of 350 mg F/kg domestic salt. The mean total F concentrations in plaque (dry wt) increased consistently with increasing exposure to F, but the absolute differences were small and the individual variation was high within each group. Significant inverse associations were demonstrated between individual plaque and surface enamel values within two groups, supported by consistent inverse trends (ns) in the remaining groups. These associations and trends are considered to reflect transfer of F from plaque to underlying surface enamel and concommitant reduction in plaque F concentration.
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Foods originating from areas where the drinking water contains 1 mg F per litre since at least 30 years were examined for their fluorine content. In the F content, no difference was found between raw vegetables, cereals, and dishes of cooked meat whether they originated from areas where the drinking water was F-poor or containing 1 mg F per litre, despite the fact that in the latter areas the vegetable gardens were watered regularly with this F-rich water for 3 decades. The mean F content of the foods originating from the F-rich water for 3 decades. The mean F content of the foods originating from the F-rich areas were 0.28 mg per kg, 0.27 mg per kg, and 0.27 mg per kg, respectively. The mean F content of soups from F-rich places was 1.5 mg per kg, and that of the dishes of cooked vegetables, though lower, was still high enough: 0.40 mg per kg. It is pointed out that watering with water containing 1 mg F per litre does not increase the F content of the foods. The higher F content found in the foods and cooked vegetables came from the drinking water used for cooking.
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