Impact of the Comprehensive Awareness Modification of Mouth, Chewing and Meal (CAMCAM) Program on the Attitude and Behavior Towards Oral Health and Eating Habits as Well as the Condition of Oral Frailty: A Pilot Study

Chewing habits and masticatory performance are associated with obesity in 9- to 10-year-old children: A cross-sectional study from the Osaka MELON Study

OBJECTIVES

This study aimed to examine the relationships of masticatory performance and chewing habits with obesity in Japanese elementary school children.

METHODS

The participants were 1,403 children aged 9-10 years in Osaka City. Chewing habits were assessed via questionnaires, and masticatory performance was measured using a color-changeable chewing gum. Obesity was determined by the percentage of overweight based on height and weight. Multivariate logistic regression analyses were conducted to calculate odds ratios for obesity, using chewing habits and masticatory performance as explanatory variables, adjusted for sex, DMFT index, and Hellman dental developmental stage.

RESULTS

Logistic regression analysis showed significant associations between obesity and sex, eating fast, and lower masticatory performance in all participants (OR=1.54, 1.73, 1.50; 95 %CI=1.08-2.17, 1.23-2.44, 1.05-2.15, respectively). In boys, eating fast, eating with mouth full, and lower masticatory performance were significantly associated with obesity (OR=1.84, 1.59, 1.63; 95 %CI=1.16-2.92, 1.03-2.46, 1.02-2.59, respectively). No variable was significantly associated in girls. When eating fast and lower masticatory performance were combined, it was significantly associated with obesity, with the strongest odds ratio observed in boys exhibiting both behaviors (OR=3.00, 95 %CI=1.49-6.07).

CONCLUSIONS

In 9- to 10-year-old children, eating fast, eating with mouth full, and lower masticatory performance were linked to obesity, particularly in boys. Furthermore, the association with obesity was higher when eating fast and lower masticatory performance were combined.

CLINICAL SIGNIFICANCE

To prevent obesity in schoolchildren, approaching the problem not only from the habitual aspect of eating fast, but also from the functional aspect of lower masticatory performance is necessary.

Factors correlated to oral frailty and number of remaining teeth among 80-year-old population in Japan

BACKGROUND

Oral frailty is proposed as a new concept defined as an age-related gradual loss of oral functions accompanied by a decline in cognitive and physical functions in older adults. Additionally, the participants with ≥ 20 remaining teeth are associated with a lower risk of cognitive frailty in older adults. Herein, we aimed to examine the correlations between the high risk of oral frailty and oral conditions or health behavior in community-dwelling 80-year-old adults in Japan. Additionally, our secondary aim was to investigate the factors associated with ≥ 20 remaining teeth.

METHODS

The present investigation was designed as a cross-sectional study using data from an adult dental health field study. This study included participants only aged 80 years in Japan. Oral frailty was evaluated using the Oral Frailty Index-8, and ≥ 4 points were defined as high risk. Oral examination was performed, and data on oral health behavior and frailty were also collected by using a self-administered questionnaire. The logistic regression analysis was conducted, with the objective variable being the risk of oral frailty groups or remaining teeth.

RESULTS

Overall,  3,222 participants ( 1,911 female and  1,311 men) were included. Among the participants,  1,217 (37.8%) had a high risk of oral frailty. The risk of oral frailty was significantly affected by smoking status, number of remaining teeth, dental plaque, oral malodor, family dental clinic, oral concerns, osteoporosis, and shrinking body weight. Logistic regression analysis revealed that a high risk of oral frailty was significantly associated with < 20 remaining teeth and poor oral behaviors. Additionally,  1,926(59.8%) participants had ≥ 20 remaining teeth. The participants with remaining teeth ≥ 20 were significantly affected by sex, smoking status, residential district, periodontal pocket, bleeding on probing, dental plaque,  and interdental cleaning. The participants with ≥ 20 remaining teeth were significantly associated with the residential district,  and interdental cleaning.

CONCLUSIONS

The main clinical implication of this study is that improving behaviors regarding oral healthcare among community-dwelling individuals may be an effective way to reduce oral frailty. Moreover, ≥ 20 remaining teeth in the 80-year-old population were notably higher in the rural areas than that in the urban areas in Japan.

Oral Frailty as a Risk Factor for Malnutrition and Sarcopenia in Patients on Hemodialysis: A Prospective Cohort Study

BACKGROUND

Oral frailty is a concept that encompasses various aspects of impaired oral function in elderly people, leading to reduced food intake and less dietary diversity, which can result in sarcopenia and physical frailty. However, there have been no studies on the relationship between oral frailty and malnutrition, sarcopenia, and physical frailty in patients on hemodialysis (HD).

METHODS

This prospective observational cohort study assessed the oral status of patients on HD. The patients were divided into an oral frailty group and non-oral frailty group using the Oral Frailty Index-8. Malnutrition was assessed using the Geriatric Nutritional Risk Index (GNRI), the Nutritional Risk Index for Japanese Hemodialysis Patients (NRI-JH), and the Short-Form Mini-Nutritional Assessment (MNA-SF). Sarcopenia was assessed using the Asian Working Group for Sarcopenia 2019's criteria. Physical frailty was assessed using the Japanese version of the Cardiovascular Health Study criteria. One year later, the changes in nutritional status, sarcopenia, and physical frailty risk categories were compared between the oral frailty and non-oral frailty groups.

RESULTS

The study enrolled 201 patients (non-oral frailty group, 123; oral frailty group, 78). After 1 year, the oral frailty group had a significantly higher proportion of patients with worsening nutrition status (GNRI, p = 0.0011; NRI-JH, p = 0.0019; MNA-SF, p < 0.001) and sarcopenia (p = 0.0024). There was no significant between-group difference in the proportion of patients in a worse risk category for physical frailty after 1 year.

CONCLUSIONS

Oral frailty predicts future malnutrition and the progression of sarcopenia in HD patients. In particular, our results strongly suggested that oral frailty was a strong determinant of worsening malnutrition and sarcopenia in HD patients aged ≥65 years.

[Research Progress on the Correlation Between Oral Frailty and Dietary Intake in Older Adults]

With the increase in age, the oral function of older adults shows an age-related decline, which limits the types, quantity, and quality of their diet. Limited dietary intake can lead to a lack of basic nutrients needed for maintaining oral health, induce a series of oral diseases, and further aggravate the deterioration of oral functions. Oral frailty is the accumulation of mild oral function decline and is an emerging concept in the field of oral health. Currently, research on oral frailty and dietary intake mostly focuses on the impact of single-dimensional oral function decline on the dietary intake, dietary structure, and dietary satisfaction of older adults, as well as the impact of different dietary structures on the status of oral health among older adults. There is still a lack of large-sample, high-quality research on the relationship between comprehensive oral function decline and dietary intake. In addition, existing oral frailty intervention measures often place a narrow emphasis on the exercise and recovery of oral function without considering the impact of dietary intake and nutritional status on the development of oral frailty. Relevant research on taking dietary intake as an entry point or using it as a comprehensive intervention method also needs to be further explored by researchers. In the future, specialized assessment and screening of dietary status may be introduced in the routine health management practices for older adults. Furthermore, targeted intervention programs could also be proposed based on the characteristics of the oral status and the dietary intake habits of older adults, so as to prevent the functional decline related to dietary intake and nutritional supplementation. Herein, we reviewed the correlation between dietary intake and oral frailty to provide new ideas and directions for formulating comprehensive management strategies for oral frailty.

Epidemiology and risk factors of oral frailty among older people: an observational study from China

OBJECTIVES

This study aimed to compare the prevalence of oral frailty among community-dwelling older people in Nanjing, China with the usage of different measurements, and to investigate the potential risk factors of oral frailty.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

A total of 338 community-dwelling older people in Nanjing, China were recruited.

METHODS

Oral frailty was measured based on the Oral Frailty Index-8 (OFI-8) scale and other measurement methods including the number of natural teeth (TN), repetitive saliva-swallowing test (RSST), and oral diadochokinesis (ODK). The chi-square test and the binary logistic regression analysis were performed to identify potential risk factors for oral frailty.

RESULTS

There were 310 participants included in the analysis. Prevalence of oral frailty by using the OFI-8, OFI-8 + TN, OFI-8 + ODK, OFI-8 + TN + ODK and RSST measurement methods were 69.0%, 27.4%, 51.9%, 21.0% and 2.9%, respectively. Passive smoking (OR = 2.04; 95%CI 1.03-4.03), being widowed/unmarried (OR1 = 2.53; 95%CI 1.25-5.10; OR2 = 2.94; 95%CI 1.12-7.77), pre-frailty (OR = 1.76; 95%CI 1.03-3.01), frailty (OR = 3.01; 95%CI 1.39-6.54), and aged 80 years and above (OR = 3.99; 95%CI 1.35-11.81) were found to be risk factors of oral frailty by the usage of the four kinds of measurement methods.

CONCLUSIONS AND IMPLICATIONS

The definition and diagnostic criteria of oral frailty are strongly needed to be unified in future research. Only subjective assessment is not enough for assessing oral frailty. Among objective indicators, RSST is not suitable as a screening method for oral frailty. In addition, objective indicators including TN and ODK should be valued for early screening and preventive interventions. The risk factors of oral frailty include physical frailty, passive smoking, and being widowed.

Untangling the Complex Interplay between Social Isolation, Anorexia, Sarcopenia, and Mortality: Insights from a Longitudinal Study

BACKGROUND

Social isolation is a pervasive and debilitating condition that has adverse prognostic impacts. This condition often co-occurs with other geriatric syndromes, further exacerbating negative health outcomes. Given these considerations, the present study aims to elucidate the roles of social isolation in older adults with anorexia of aging and/or sarcopenia with respect to long-term mortality using a nationally representative cohort study.

METHODS

Data were obtained from the Taiwan Longitudinal Study on Aging (TLSA), with a sample size of 3,762 study participants aged 50 years and older. Data from 1999 (wave 4) to 2015 (wave 9) were analyzed. The TLSA questionnaire was used to define social isolation, anorexia, and sarcopenia. Logistic regressions were employed to explore the associations between social isolation, anorexia, and sarcopenia. The Cox proportional hazard model was utilized to examine the synergistic effects of social isolation and anorexia or sarcopenia on 16-year all-cause mortality.

RESULTS

After controlling for demographic information and comorbidities, older adults with social isolation were significantly associated with anorexia (adjusted odds ratio [aOR] 1.46 [95% confidence interval: 1.00-2.12, p=0.0475]) and sarcopenia (aOR 1.35 [95% CI: 1.12-1.64, p=0.0021]). Furthermore, the synergistic effects of social isolation with anorexia (aOR 1.65 [95% CI: 1.25-2.18, p=0.0004]) or sarcopenia (aOR 1.65 [95% CI: 1.42-1.92, p<0.0001]) were both significantly associated with higher risks of all-cause mortality, while social isolation alone revealed borderline statistical significance.

CONCLUSIONS

Our findings indicate that social isolation is closely linked to anorexia and sarcopenia among middle-aged and older adults. Additionally, social isolation significantly exacerbates the long-term mortality risk associated with anorexia of aging and sarcopenia. However, social isolation alone appears to have borderline long-term mortality risk in this cohort. These findings underscore the importance of addressing social isolation in older adults with anorexia and/or sarcopenia to optimize their health outcomes and mitigate long-term mortality risk.