Impact of a Healthy City Program on oral health and nutritional habits of middle school students in Riyadh, Saudi Arabia: a cross-sectional study.

BACKGROUND: In 1988, the World Health Organization launched the Healthy City Program (HCP), which seeks to improve health and well-being by empowering local communities. This study aimed to assess the impact of HCP nutritional education on middle school children by comparing general and oral health, nutritional status, and dietary outcomes between participating and non-participating schools. METHODS: A cross-sectional study was conducted among 1200 school children from three HCP schools and five control non-HCP schools in Saudi Arabia. Data were collected using questionnaires on self-reported general health, oral health, and dietary intake. Nutritional status was assessed using Body Mass Index (BMI). Caries prevalence (Decayed Missing Filled Teeth DMFT) and Gingival health (Bleeding on Probing, BOP) were evaluated using oral examinations. Statistical tests, including chi-square test, Pearson correlation test, and multinomial logistic regression, were applied. Statistical significance was set at p value < 0.05. RESULTS: HCP students had better self-reported general health and oral health. However, both groups had high consumption of unhealthy foods, with control students consuming more fruits and junk food. The mean number of DMFT was significantly lower in the HCP group (3.50 ± 2.40) than in the control group (4.96 ± 3.59) (p < 0.001). The mean number of teeth with Bleeding on Probing (BOP) was significantly lower in the HCP group (11.12 ± 9.81) than in the control group (14.49 ± 11.82) (p < 0.001), and unhealthy diet scores were positively correlated with BMI (r = 0.088, p = 0.002) and DMFT (r = 0.074, p = 0.012). According to the regression analysis, an unhealthy diet was significantly associated with increased odds of dental caries (OR = 1.26, p = 0.002), whereas HCP participation was associated with lower odds of dental caries (OR = 0.54, p < 0.001). The risk of caries was not significantly predicted by BMI, age, or sex, although brushing twice a day was protective (OR = 0.55, p = 0.003). CONCLUSION: Although HCP led to improvements in self-perceived general and oral health, its effect on dietary habits was less evident, with no evident benefit in terms of encouraging the use of healthier foods.