# The relationship of dental caries and weight status with adherence to school nutrition policies among public primary school children in Riyadh: a cross-sectional study

## TL;DR

This study found no clear link between school food policy adherence and dental caries or weight status in Saudi primary school children.

## Contribution

The study provides new evidence on the effectiveness of school nutrition policies in Riyadh, KSA, in relation to children's oral health and weight.

## Key findings

- Adherence to school food policies showed no significant effect on dental caries severity or prevalence.
- There was no significant effect of policy adherence on the prevalence of overweight and obesity.
- Children consuming biscuits, cakes, or sugary drinks more frequently had higher odds of dental caries or being overweight/obese.

## Abstract

Since 2014, the Saudi Ministry of Health and Education has developed and required the implementation of the “Regulations of Health Conditions for School Canteens.” The Saudi Ministry of Education states these school food guidelines provide educational institutions a list of foods that are permitted as well as those that are prohibited, which they must adhere to. The aim of this research is to explore the relationship of dental caries and weight status with adherence to school food policy in public primary schools in Riyadh, Kingdom of Saudi Arabia (KSA).

A cross-sectional study was conducted among public primary school children in Riyadh, KSA. A total of 14 schools were randomly selected from five different regions and identified in a previous study that explored school adherence to the school canteen policy set by the Ministry of Education in Riyadh, KSA. Seven schools that had an average adherence to the school canteen policy and seven schools that did not adhere were included in this study. The severity and prevalence of dental caries, as well as the prevalence of overweight and obesity in children, were assessed according to World Health Organization (WHO) criteria. Additionally, parents were asked to complete a structured questionnaire to evaluate their child’s oral health by using the WHO, Oral Health Questionnaire for Children.

This study found there is no evidence of an effect of adherence to school food policies on either the severity or prevalence of dental caries. Similarly, no evidence of an effect of adherence to school food policies on the prevalence of overweight and obesity among public primary schools in Riyadh, Saudi Arabia, with (IRR = 0.96, 95% CI: 0.80, 1.17, p-value = 0.714), (OR = 1.01, 95% CI: 0.605, 1.69, p-value = 0.960 ), and ( OR = 0.80, 95% CI: -0.57, 1.13, p-value = 0.207), respectively. However, based on parents’ perception of their children’s eating habits, there was evidence that children who ate biscuits and cakes at least once a week showed 78.2% lower odds of being caries free compared to once a month or never (OR = 0.21, 95% CI: 0.04, 1.00, p = 0.050). Additionally, children who consumed sugar-filled beverages daily or at least once a weekly had lower odds of being non-overweight/obese compared to those who consumed them once a month or never (OR = 0.63, 95% CI: 0.40, 0.97, p = 0.037) (OR = 0.63, 95% CI: 0.40, 0.98, p = 0.042).

There was no evidence of a difference between the level of adherence to Ministry of Education school canteen guidelines in public primary schools and dental caries experience or weight status of students. However, due to the level of school canteen compliance being either ‘poor’ or ‘average’, a clear conclusion cannot be reached.

The online version contains supplementary material available at 10.1186/s12889-025-24979-0.