Jẹ díjẹ dí, Free Sugar Consumption and Early Childhood Caries Experience in Ile-Ife, Nigeria: A Cultural Dimension to Caries Risk

Morenike Oluwatoyin Folayan^1,2*Roberto Ariel Abeldaño Zuñiga^3,4Omolola T. Alade^2,5Oluwabunmi Tope Bernard^2,6Olaniyi Arowolo²Taofeek Kolawole Aliyu²Olusegun Stephen Titus²Simin Z. Mohebbi⁷Mohammad Khami⁸

• ¹Center for Reproduction and Population Health Studies, Nigerian Institute of Medical Research (NIMR), Lagos, Nigeria
• ²Obafemi Awolowo University, Ife, Osun, Nigeria
• ³University of Sierra Sur,, Oaxaca,, Mexico
• ⁴University of Helsinki, Helsinki, Uusimaa, Finland
• ⁵McMaster University, Hamilton, Ontario, Canada
• ⁶Ghent University, Ghent, East Flanders, Belgium
• ⁷Tehran University of Medical Sciences, Tehran, Tehran, Iran
• ⁸University of Tehran, Tehran, Tehran, Iran

Background: Jẹdíjẹdí is a Yoruba ethnomedical gastrointestinal phenomenon associated with reduced refined carbohydrate consumption. This study assessed the associations between maternal belief in 'jẹ ̀díjẹ ̀dí' and age of sugar introduction into children's diets, daily frequency of refined carbohydrate consumption between meals, and early childhood caries (ECC) experience in Ile-Ife, Nigeria. Methods: This study involved a secondary analysis of crosssectional data collected from 878 mother-child dyads residing in Ile-Ife Central Local Government Area between December 2024 and January 2025. Participants were selected through a multi-stage random sampling process. Data were collected using structured, interviewer-administered questionnaires as well as clinical dental examinations that used the decayed, missing, and filled teeth (dmft) index. Three separate multivariable logistic regression models were employed to assess the association between maternal belief in jẹ ̀díjẹ ̀dí and three oral health outcomes (age of introduction of sugar into diet, frequency of consumption of refined carbohydrate between meals daily, and ECC experience). These models adjusted for covariates (socioeconomic status as a contextual factor; the child's age, sex, use of fluoride toothpaste, and toothbrushing frequency as child-level factors; and the mother's age and knowledge of caries prevention as mother-level factors). Results: Among the 878 children included in the study, 538 (61.3%) had been introduced to refined carbohydrates before their first birthday, 202 (23.0%) consumed refined carbohydrates more than three times per day between meals, 713 (81.2%) expressed belief in jẹ ̀díjẹ ̀dí, while 70 (8.0%) children have ECC. Maternal belief in jẹ ̀díjẹ ̀dí was associated with non-significant trends suggesting a possible delay in sugar introduction (adjusted odds ratio [AOR]: 1.119; 95% confidence interval [CI]: 0.776-1.614; p = 0.547) and a lower frequency of refined carbohydrate consumption (AOR: 1.412; 95% CI: 0.942-2.115; p = 0.095). There was no significant association observed between belief in jẹ ̀díjẹ ̀dí and the presence of ECC (AOR: 1.002; 95% CI: 0.516-1.947; p = 0.995). Conclusion: While maternal belief in jẹ ̀díjẹ ̀dí was not significantly associated with the oral health outcomes, it demonstrated a tendency toward protective dietary practices. Future studies should explore leveraging jẹ ̀díjẹ ̀dí within culturally tailored ECC prevention programs.